Provider Demographics
NPI:1619089893
Name:FAIN, LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:FAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1505
Mailing Address - Country:US
Mailing Address - Phone:516-635-5736
Mailing Address - Fax:516-594-4053
Practice Address - Street 1:46 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1505
Practice Address - Country:US
Practice Address - Phone:516-635-5736
Practice Address - Fax:516-594-4053
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0560341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1K991Medicare ID - Type Unspecified