Provider Demographics
NPI:1053647693
Name:LYNCH, HEATHER (PSYCHOLOGIST-MASTER)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PSYCHOLOGIST-MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4635
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05406-4635
Mailing Address - Country:US
Mailing Address - Phone:802-343-1701
Mailing Address - Fax:
Practice Address - Street 1:34 PATCHEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5704
Practice Address - Country:US
Practice Address - Phone:802-343-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-01
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0045057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017144Medicaid