Provider Demographics
NPI:1306215371
Name:IRWIN, LYNN (PSYA D)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:IRWIN
Suffix:
Gender:M
Credentials:PSYA D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 66
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033
Mailing Address - Country:US
Mailing Address - Phone:802-222-9235
Mailing Address - Fax:802-222-5864
Practice Address - Street 1:331 UPPER PLAIN (U.S ROUTE 5)
Practice Address - Street 2:BRADFORD MEDICAL CENTER
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033
Practice Address - Country:US
Practice Address - Phone:802-222-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098.0133629102L00000X
103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst