Provider Demographics
NPI:1083034300
Name:LYNCH, KIMBERLY Y (MA, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:Y
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1470
Mailing Address - Country:US
Mailing Address - Phone:574-999-0814
Mailing Address - Fax:
Practice Address - Street 1:711 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1470
Practice Address - Country:US
Practice Address - Phone:574-999-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006823A104100000X
IN34007408A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker