Provider Demographics
NPI:1003571787
Name:WOLFSON, LYNSEY (LMSW)
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4339
Mailing Address - Country:US
Mailing Address - Phone:516-924-0502
Mailing Address - Fax:
Practice Address - Street 1:55 BIRCH ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4339
Practice Address - Country:US
Practice Address - Phone:516-924-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080100-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker