Provider Demographics
NPI:1558486357
Name:REPETOSKY, LYNN M (LMHC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:REPETOSKY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:PEACE RIVER CENTER
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-1559
Mailing Address - Country:US
Mailing Address - Phone:863-519-0575
Mailing Address - Fax:863-582-9251
Practice Address - Street 1:1825 N GILMORE AVENUE
Practice Address - Street 2:PEACE RIVER CENTER
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-248-3300
Practice Address - Fax:863-582-9251
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107617700Medicaid