Provider Demographics
NPI:1407191026
Name:LYNCOOK, LORREL (MS,)
Entity Type:Individual
Prefix:
First Name:LORREL
Middle Name:
Last Name:LYNCOOK
Suffix:
Gender:F
Credentials:MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DOHERTY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2413
Mailing Address - Country:US
Mailing Address - Phone:917-476-9214
Mailing Address - Fax:
Practice Address - Street 1:64 DOHERTY AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2413
Practice Address - Country:US
Practice Address - Phone:917-476-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY709887103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst