Provider Demographics
NPI:1255522587
Name:EVANSOHN, LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:EVANSOHN
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 1:3126 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3306
Mailing Address - Country:US
Mailing Address - Phone:718-549-3941
Mailing Address - Fax:718-601-3513
Practice Address - Street 1:180 PONDFIELD RD
Practice Address - Street 2:COUNSELING CENTER
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4811
Practice Address - Country:US
Practice Address - Phone:914-793-3388
Practice Address - Fax:914-793-0094
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO13680-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN56191Medicare PIN