Provider Demographics
NPI:1770630139
Name:O'HARA, LYNN (MS, RD, LPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:MS, RD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 W LAKE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BAY HEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-5000
Mailing Address - Country:US
Mailing Address - Phone:732-899-9312
Mailing Address - Fax:732-899-8191
Practice Address - Street 1:571 W LAKE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BAY HEAD
Practice Address - State:NJ
Practice Address - Zip Code:08742-5000
Practice Address - Country:US
Practice Address - Phone:732-899-9312
Practice Address - Fax:732-899-8191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NJ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional