Provider Demographics
NPI:1336505478
Name:LYNCH, MARTIN D (MS LPC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:D
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 NORTH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5609
Mailing Address - Country:US
Mailing Address - Phone:203-313-7356
Mailing Address - Fax:
Practice Address - Street 1:70 NORTH ST STE 201
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5609
Practice Address - Country:US
Practice Address - Phone:203-313-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional