Provider Demographics
NPI:1881180396
Name:HENRY, LYNNE CONOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:CONOLE
Last Name:HENRY
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 1:1 MATHAURS ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4609
Mailing Address - Country:US
Mailing Address - Phone:315-373-8015
Mailing Address - Fax:
Practice Address - Street 1:70 PUTNEY LN
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-7836
Practice Address - Country:US
Practice Address - Phone:315-314-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical