Provider Demographics
NPI:1891761359
Name:RODDY, LYNNE ANN (LICSW MSW)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:ANN
Last Name:RODDY
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 WOOD ROAD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-794-2300
Mailing Address - Fax:781-794-2215
Practice Address - Street 1:340 WOOD ROAD
Practice Address - Street 2:SUITE 306
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-794-2300
Practice Address - Fax:781-794-2215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100771104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
S61812Medicare UPIN
P20924Medicare ID - Type Unspecified