Provider Demographics
NPI:1164784054
Name:LYNN, LISBETH SMITH
Entity Type:Individual
Prefix:MRS
First Name:LISBETH
Middle Name:SMITH
Last Name:LYNN
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 1:52 SOULARD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-3714
Mailing Address - Country:US
Mailing Address - Phone:914-381-9355
Mailing Address - Fax:914-381-9356
Practice Address - Street 1:52 SOULARD ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-3714
Practice Address - Country:US
Practice Address - Phone:914-381-9355
Practice Address - Fax:914-381-9356
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist