Provider Demographics
NPI:1447401088
Name:LYNCH, LISA M (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HILL ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3025
Mailing Address - Country:US
Mailing Address - Phone:617-834-8111
Mailing Address - Fax:
Practice Address - Street 1:155 NEW BOSTON ST STE U174
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6297
Practice Address - Country:US
Practice Address - Phone:978-364-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1145841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical