Provider Demographics
NPI:1275542094
Name:LYNN, DEBORA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:
Last Name:LYNN
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 1:15 TORREY STREET
Mailing Address - Street 2:CHANGING DIRECTIONS COUNSELING
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-580-3193
Mailing Address - Fax:508-580-3198
Practice Address - Street 1:15 TORREY STREET
Practice Address - Street 2:CHANGING DIRECTIONS COUNSELING
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-580-3193
Practice Address - Fax:508-580-3198
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1059921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21483Medicare ID - Type Unspecified