Provider Demographics
NPI:1922388099
Name:DIFATTA, LYNN ANN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:DIFATTA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-1229
Mailing Address - Country:US
Mailing Address - Phone:410-549-3196
Mailing Address - Fax:410-549-3197
Practice Address - Street 1:1311 LONDONTOWN BLVD
Practice Address - Street 2:SUITE 130A
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6454
Practice Address - Country:US
Practice Address - Phone:410-552-0773
Practice Address - Fax:410-549-3197
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical