Provider Demographics
NPI:1346839396
Name:LYNCH, JOHN ERIC (LMSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIC
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DENISE CT
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-4005
Mailing Address - Country:US
Mailing Address - Phone:631-972-5121
Mailing Address - Fax:
Practice Address - Street 1:215 HALLOCK RD STE 1A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3079
Practice Address - Country:US
Practice Address - Phone:631-551-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107736104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty