Provider Demographics
NPI:1275999617
Name:MYRTHIL, LYNELEY
Entity Type:Individual
Prefix:
First Name:LYNELEY
Middle Name:
Last Name:MYRTHIL
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 1:245 HAWTHORNE ST
Mailing Address - Street 2:D12
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 HAWTHORNE ST
Practice Address - Street 2:D12
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5931
Practice Address - Country:US
Practice Address - Phone:347-737-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency