Provider Demographics
NPI:1710490982
Name:LYNCH, TARA-LEE ANN
Entity Type:Individual
Prefix:
First Name:TARA-LEE
Middle Name:ANN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-2605
Mailing Address - Country:US
Mailing Address - Phone:978-569-5316
Mailing Address - Fax:
Practice Address - Street 1:16 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-2605
Practice Address - Country:US
Practice Address - Phone:978-569-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician