Provider Demographics
NPI:1518081298
Name:HERBST, LYNNE RECCHIA (RCSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:RECCHIA
Last Name:HERBST
Suffix:
Gender:F
Credentials:RCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3227
Mailing Address - Country:US
Mailing Address - Phone:914-833-2149
Mailing Address - Fax:914-833-2736
Practice Address - Street 1:39 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4124
Practice Address - Country:US
Practice Address - Phone:212-772-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0272461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR027246OtherLIC.CLINICAL SOC. WORKER