Provider Demographics
NPI:1154440121
Name:KWALWASSER, LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:
Last Name:KWALWASSER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 LAFAYETTE ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3355
Mailing Address - Country:US
Mailing Address - Phone:212-219-1791
Mailing Address - Fax:212-219-1791
Practice Address - Street 1:284 LAFAYETTE ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3355
Practice Address - Country:US
Practice Address - Phone:212-219-1791
Practice Address - Fax:212-219-1791
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006017-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical