Provider Demographics
NPI:1154463263
Name:LYNN, ADAM M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:M
Last Name:LYNN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 PELHAM PKWY S
Mailing Address - Street 2:APT 1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3726
Mailing Address - Country:US
Mailing Address - Phone:718-823-4864
Mailing Address - Fax:
Practice Address - Street 1:1910 PELHAM PKWY S
Practice Address - Street 2:APT 1B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3726
Practice Address - Country:US
Practice Address - Phone:718-823-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02022920Medicaid
NY02022920Medicaid