Provider Demographics
NPI:1659506152
Name:ROSTAR, LYNDA H (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:H
Last Name:ROSTAR
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 1:102 FOX HAVEN DR
Mailing Address - Street 2:#A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9720
Mailing Address - Country:US
Mailing Address - Phone:252-353-7025
Mailing Address - Fax:252-353-7028
Practice Address - Street 1:102 FOX HAVEN DR
Practice Address - Street 2:#A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-9720
Practice Address - Country:US
Practice Address - Phone:252-353-7025
Practice Address - Fax:252-353-7028
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0061811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC006181OtherNC LCSW LICENSE