Provider Demographics
NPI:1629563911
Name:LYNCH, KRISTINE (MED BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 PROVIDENCE LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7059
Mailing Address - Country:US
Mailing Address - Phone:561-346-0672
Mailing Address - Fax:
Practice Address - Street 1:1053 PROVIDENCE LN
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7059
Practice Address - Country:US
Practice Address - Phone:561-346-0672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-18-30620103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst