Provider Demographics
NPI:1629698782
Name:PUMA, LYNN B (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:B
Last Name:PUMA
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 1:158 CLOVER BANK RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-7872
Mailing Address - Country:US
Mailing Address - Phone:704-649-2498
Mailing Address - Fax:
Practice Address - Street 1:158 CLOVER BANK RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-7872
Practice Address - Country:US
Practice Address - Phone:704-649-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC005353OtherNC SOCIAL LICENSE & CERTIFICATION BOARD