Provider Demographics
NPI:1760517940
Name:LYNCH, MARTHA DILL (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:DILL
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:MARTY
Other - Middle Name:DILL
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:256C MONROE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1016
Mailing Address - Country:US
Mailing Address - Phone:650-483-6742
Mailing Address - Fax:
Practice Address - Street 1:256C MONROE DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1016
Practice Address - Country:US
Practice Address - Phone:650-483-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist