Provider Demographics
NPI:1265802607
Name:LYNCH, THEODORE ANDREW (ASW)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:ANDREW
Last Name:LYNCH
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0217
Mailing Address - Country:US
Mailing Address - Phone:530-410-2287
Mailing Address - Fax:
Practice Address - Street 1:630 AZALEA AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0217
Practice Address - Country:US
Practice Address - Phone:530-410-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA686181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical