Provider Demographics
NPI:1942554613
Name:DELMASTRO, LYN ANN (MA, RYT)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:ANN
Last Name:DELMASTRO
Suffix:
Gender:F
Credentials:MA, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1258
Mailing Address - Country:US
Mailing Address - Phone:503-347-0258
Mailing Address - Fax:
Practice Address - Street 1:5525 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1258
Practice Address - Country:US
Practice Address - Phone:503-347-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor