Provider Demographics
NPI:1558018044
Name:AUDETTE, LILLIAN MARIE LYNCH (PHD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARIE LYNCH
Last Name:AUDETTE
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 1:27 TRAPELO ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3132
Mailing Address - Country:US
Mailing Address - Phone:202-236-0415
Mailing Address - Fax:
Practice Address - Street 1:140 COMMONWEALTH AVE # 001
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3858
Practice Address - Country:US
Practice Address - Phone:617-552-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling