Provider Demographics
NPI:1669652434
Name:SCARBOROUGH, LYNN M (ASW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:M
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 SHELBY PLACE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-553-5819
Mailing Address - Fax:707-553-5824
Practice Address - Street 1:3290 SHELBY PL
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-4312
Practice Address - Country:US
Practice Address - Phone:707-553-5819
Practice Address - Fax:707-553-5824
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 226461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical