Provider Demographics
NPI:1750322723
Name:CONBOY, LYNNE TAMAZON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:TAMAZON
Last Name:CONBOY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 CHARLIE DR
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21813-1643
Mailing Address - Country:US
Mailing Address - Phone:410-629-0100
Mailing Address - Fax:410-629-0710
Practice Address - Street 1:10031 OLD OCEAN CITY BLVD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1173
Practice Address - Country:US
Practice Address - Phone:410-629-0100
Practice Address - Fax:410-629-0710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD090391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD838RMedicare ID - Type Unspecified