Provider Demographics
NPI:1619207222
Name:LYNCH, JESSICA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:LYNCH
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 1:7550 SOUTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:LAWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367
Mailing Address - Country:US
Mailing Address - Phone:315-376-5450
Mailing Address - Fax:315-376-7221
Practice Address - Street 1:7550 SOUTH STATE STREET
Practice Address - Street 2:
Practice Address - City:LAWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367
Practice Address - Country:US
Practice Address - Phone:315-376-5450
Practice Address - Fax:315-376-7221
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39301041C0700X
NY0769791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical