Provider Demographics
NPI:1689816159
Name:POLICASTRO, LYNN KEITH (BS, ED)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:KEITH
Last Name:POLICASTRO
Suffix:
Gender:F
Credentials:BS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 CHALCOMBE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4127
Mailing Address - Country:US
Mailing Address - Phone:919-846-7798
Mailing Address - Fax:
Practice Address - Street 1:7829 PERCUSSION DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-3611
Practice Address - Country:US
Practice Address - Phone:919-363-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist