Provider Demographics
NPI:1104055664
Name:CHEVALIER-RAY, LYNNE (LICSW)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:CHEVALIER-RAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CABOT RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5177
Mailing Address - Country:US
Mailing Address - Phone:781-395-0257
Mailing Address - Fax:
Practice Address - Street 1:10 CABOT RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5177
Practice Address - Country:US
Practice Address - Phone:781-395-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1141471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical