Provider Demographics
NPI:1760558035
Name:KAGARISE, LYNN E (MS)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:E
Last Name:KAGARISE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PENN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1615
Mailing Address - Country:US
Mailing Address - Phone:814-643-1756
Mailing Address - Fax:814-643-5670
Practice Address - Street 1:504 PENN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1615
Practice Address - Country:US
Practice Address - Phone:814-643-1756
Practice Address - Fax:814-643-5670
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005038L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist