Provider Demographics
NPI:1467670588
Name:EDMONDS, LYNN RUTH (RN, MS)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:RUTH
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:KEENE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12943-0042
Mailing Address - Country:US
Mailing Address - Phone:518-576-9721
Mailing Address - Fax:
Practice Address - Street 1:2841 NYS ROUTE 73 STE 3
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NY
Practice Address - Zip Code:12942-9998
Practice Address - Country:US
Practice Address - Phone:518-576-4557
Practice Address - Fax:517-576-9713
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192617-1101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist