Provider Demographics
NPI:1992847305
Name:DOVE, LYNN KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:KAREN
Last Name:DOVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12C LEDGEBROOK DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1664
Mailing Address - Country:US
Mailing Address - Phone:860-423-3065
Mailing Address - Fax:860-423-3566
Practice Address - Street 1:12C LEDGEBROOK DR
Practice Address - Street 2:SUITE #3
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1664
Practice Address - Country:US
Practice Address - Phone:860-423-3065
Practice Address - Fax:860-423-3566
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140004648CT02OtherANTHEM BEHAVIORAL HEALTH
CT237488OtherMHN
CT62-25415OtherUNITED BEHAVIORAL HEALTH