Provider Demographics
NPI:1164021705
Name:LYNCH, VALESTA JUDY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:VALESTA
Middle Name:JUDY
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9113 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1145
Mailing Address - Country:US
Mailing Address - Phone:347-933-3877
Mailing Address - Fax:
Practice Address - Street 1:1660 E NEW YORK AVE UNIT 211
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-8016
Practice Address - Country:US
Practice Address - Phone:347-933-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty