Provider Demographics
NPI:1790774735
Name:LYNCH, VERONICA ROSETTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:ROSETTA
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WILLOUGHBY AVE
Mailing Address - Street 2:STE 413
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3843
Mailing Address - Country:US
Mailing Address - Phone:718-783-1033
Mailing Address - Fax:718-783-1033
Practice Address - Street 1:195 WILLOUGHBY AVE
Practice Address - Street 2:STE 413
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3843
Practice Address - Country:US
Practice Address - Phone:347-526-5116
Practice Address - Fax:718-783-1033
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0333641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01563088Medicaid
NY01563088Medicaid