Provider Demographics
NPI:1164137600
Name:LYNCH-BARTEK, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LYNCH-BARTEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CARDINAL WAY
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2578
Mailing Address - Country:US
Mailing Address - Phone:617-962-2776
Mailing Address - Fax:
Practice Address - Street 1:25 CARDINAL WAY
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2578
Practice Address - Country:US
Practice Address - Phone:617-962-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA2108811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical