Provider Demographics
NPI:1528559390
Name:LYNCH, EILEEN MARGARET
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARGARET
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NIMBUS RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4419
Mailing Address - Country:US
Mailing Address - Phone:631-645-6102
Mailing Address - Fax:
Practice Address - Street 1:108 NIMBUS RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4419
Practice Address - Country:US
Practice Address - Phone:631-645-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency