Provider Demographics
NPI:1114182565
Name:LYNCH, JOHN EDWARD (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E MAIN ST
Mailing Address - Street 2:#11
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3139
Mailing Address - Country:US
Mailing Address - Phone:203-481-3001
Mailing Address - Fax:
Practice Address - Street 1:230 E MAIN ST
Practice Address - Street 2:#11
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3139
Practice Address - Country:US
Practice Address - Phone:203-481-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist