Provider Demographics
NPI:1295268092
Name:LISA M LYNCH, LICSW LLC
Entity type:Organization
Organization Name:LISA M LYNCH, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-364-0214
Mailing Address - Street 1:44 HILL ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3025
Mailing Address - Country:US
Mailing Address - Phone:978-364-0214
Mailing Address - Fax:
Practice Address - Street 1:80 MAPLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3143
Practice Address - Country:US
Practice Address - Phone:978-364-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114584302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization