Provider Demographics
NPI:1295132975
Name:MODZELESKY, LYNNE ANN (PSYD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANN
Last Name:MODZELESKY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:ANN
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2100 NAPA VALLEJO HWY.
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6293
Mailing Address - Country:US
Mailing Address - Phone:707-253-5654
Mailing Address - Fax:707-253-5097
Practice Address - Street 1:3404 BLACK TOWER CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8097
Practice Address - Country:US
Practice Address - Phone:610-425-0752
Practice Address - Fax:707-253-5097
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29009103TC0700X
PAPS017705103TC0700X
NC6144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical