Provider Demographics
NPI:1518066174
Name:LYNCH, ROBIN M (PHD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 W 237TH ST APT 8D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1447
Mailing Address - Country:US
Mailing Address - Phone:917-922-3773
Mailing Address - Fax:
Practice Address - Street 1:640 W 237TH ST APT 8D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1447
Practice Address - Country:US
Practice Address - Phone:917-922-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013654103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01949522Medicaid
NY01949522Medicaid