Provider Demographics
NPI:1629246384
Name:STANLEY, LYNNE MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:MARIE
Other - Last Name:MCKITRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1402 BELLEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1512
Mailing Address - Country:US
Mailing Address - Phone:740-282-9415
Mailing Address - Fax:304-234-3511
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3570
Practice Address - Fax:304-234-3511
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943083104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPENDINGOtherBCBS