Provider Demographics
NPI:1922539527
Name:LYNCH, DANIEL (LADC-1 CIP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LADC-1 CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WASHINGTON ST
Mailing Address - Street 2:SUITE D-25
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1740
Mailing Address - Country:US
Mailing Address - Phone:781-878-7111
Mailing Address - Fax:
Practice Address - Street 1:80 WASHINGTON ST
Practice Address - Street 2:SUITE D-25
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1740
Practice Address - Country:US
Practice Address - Phone:781-878-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA749101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI0116OtherCIP
MA749OtherLADC-1