Provider Demographics
NPI:1497048599
Name:LYNN, MARY J (MS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:LYNN
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 1:132 GLEASON CV
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4451
Mailing Address - Country:US
Mailing Address - Phone:407-733-6706
Mailing Address - Fax:
Practice Address - Street 1:132 GLEASON CV
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4451
Practice Address - Country:US
Practice Address - Phone:407-733-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health