Provider Demographics
NPI:1043348964
Name:FRONK, LYNN P (SW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:P
Last Name:FRONK
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TEXAS ST NE
Mailing Address - Street 2:HAYES MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7814
Mailing Address - Country:US
Mailing Address - Phone:505-265-7741
Mailing Address - Fax:
Practice Address - Street 1:1100 TEXAS ST NE
Practice Address - Street 2:HAYES MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7814
Practice Address - Country:US
Practice Address - Phone:505-265-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 60061041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15325059Medicaid