Provider Demographics
NPI:1558449967
Name:GAVIGAN, LYNN (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:GAVIGAN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:560 RIVERSIDE DR STE B101
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4701
Practice Address - Country:US
Practice Address - Phone:443-978-8688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD096111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522156095OtherUNITED BEHAVIORAL HEALTH
MDLM49EAOtherCAREFIRST BCBS GROUP
MD259147000OtherMAGELLAN GROUP
517251OtherUHC MAMSI GROUP#
0001OtherCAREFIRST FEDERAL PIN
MD81030602OtherCAREFIRST BCBS PIN
R968OtherCAREFIRST FEDERAL GROUP
724332OtherNCPPO PIN
PVPB127119OtherAMERICAN PSYCH SYSTEM
2104268OtherUNITED HEALTH CARE MAMSI
MD229696000OtherMAGELLAN PIN
5221560950002OtherTRICARE