Provider Demographics
NPI:1578081006
Name:LYNN, BREASIA Z
Entity Type:Individual
Prefix:
First Name:BREASIA
Middle Name:Z
Last Name:LYNN
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 1:650 27TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3116
Mailing Address - Country:US
Mailing Address - Phone:727-244-2708
Mailing Address - Fax:
Practice Address - Street 1:3190 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2919
Practice Address - Country:US
Practice Address - Phone:727-345-9111
Practice Address - Fax:727-345-7130
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician