Provider Demographics
NPI:1043319759
Name:TISHMAN, LYNN P (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:P
Last Name:TISHMAN
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-988-8855
Mailing Address - Fax:
Practice Address - Street 1:329 E 62ND ST
Practice Address - Street 2:KAREN HORNEY CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7705
Practice Address - Country:US
Practice Address - Phone:212-838-4333
Practice Address - Fax:212-838-7158
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0521941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9G191Medicare ID - Type Unspecified