Provider Demographics
NPI:1033530944
Name:LYNCH, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WASHINGTON BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5703
Mailing Address - Country:US
Mailing Address - Phone:703-228-1706
Mailing Address - Fax:703-228-1756
Practice Address - Street 1:2100 WASHINGTON BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5703
Practice Address - Country:US
Practice Address - Phone:703-228-1706
Practice Address - Fax:703-228-1756
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003677103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810003677OtherBOARD OF PSYCHOLOGY