Provider Demographics
NPI:1558587220
Name:ANDERSON, LYNN MICHAEL (MS)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:MICHAEL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-1523
Mailing Address - Country:US
Mailing Address - Phone:717-940-6820
Mailing Address - Fax:717-295-7127
Practice Address - Street 1:309 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1523
Practice Address - Country:US
Practice Address - Phone:717-940-6820
Practice Address - Fax:717-295-7127
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003743L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01502820Medicaid
PA01502820Medicaid
PA7314040Medicare ID - Type Unspecified