Provider Demographics
NPI:1467419309
Name:LYNCH, PETER B I (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:B
Last Name:LYNCH
Suffix:I
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1231
Mailing Address - Country:US
Mailing Address - Phone:203-782-6645
Mailing Address - Fax:
Practice Address - Street 1:117 LINCOLN ST
Practice Address - Street 2:CHILD GUIDANCE CLINIC
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-3163
Practice Address - Country:US
Practice Address - Phone:203-235-5767
Practice Address - Fax:203-238-2010
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0021841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT197088OtherMHN/HMC
CT140002184CT03OtherANTHEM BEH, BCBS
CT329553OtherVALU OPT
CT00308670000OtherBC FAMILY PLAN
CT140002184CT03OtherANTHEM BEH, BCBS