Provider Demographics
NPI:1386833465
Name:EGGLETON, LYNN MAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MAE
Last Name:EGGLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6878 NAVAJO RD UNIT 91
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1572
Mailing Address - Country:US
Mailing Address - Phone:619-741-3464
Mailing Address - Fax:
Practice Address - Street 1:6878 NAVAJO RD UNIT 91
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1572
Practice Address - Country:US
Practice Address - Phone:619-741-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS165021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical