Provider Demographics
NPI:1629126933
Name:LYN, JODI LOUISE (MHSC)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LOUISE
Last Name:LYN
Suffix:
Gender:F
Credentials:MHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16525 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3609
Mailing Address - Country:US
Mailing Address - Phone:305-944-1313
Mailing Address - Fax:
Practice Address - Street 1:2771 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 6
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3642
Practice Address - Country:US
Practice Address - Phone:954-745-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist