Provider Demographics
NPI:1598121535
Name:LYNCH, JACLYN MARIE (MS BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MARIE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:MRS
Other - First Name:JACLYN
Other - Middle Name:MARIE
Other - Last Name:CADRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS BCBA
Mailing Address - Street 1:345 A GREENWOOD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1767
Mailing Address - Country:US
Mailing Address - Phone:508-363-0200
Mailing Address - Fax:508-363-1213
Practice Address - Street 1:345 A GREENWOOD ST
Practice Address - Street 2:SUITE B
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1767
Practice Address - Country:US
Practice Address - Phone:508-363-0200
Practice Address - Fax:508-363-1213
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst