Provider Demographics
NPI:1851874259
Name:ST.LOUIS, LYNNE ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:ANN
Last Name:ST.LOUIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2352
Mailing Address - Country:US
Mailing Address - Phone:508-561-7843
Mailing Address - Fax:
Practice Address - Street 1:20 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2352
Practice Address - Country:US
Practice Address - Phone:508-561-7843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020281-SW-LICSW1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool