Provider Demographics
NPI:1356449037
Name:AFONSO LYNES, LISA C (LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:AFONSO LYNES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2603
Mailing Address - Country:US
Mailing Address - Phone:401-721-9200
Mailing Address - Fax:
Practice Address - Street 1:621 DEXTER ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2603
Practice Address - Country:US
Practice Address - Phone:401-721-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
RIMHC00418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412296OtherEI BCHIP
RI2092OtherEI NHPRC
RI292177OtherEI BLUE CROSS
RIES01788Medicaid
RI6400144OtherEI UHP