Provider Demographics
NPI:1295700938
Name:LYNCH, JAMES F (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BUILDING 5D
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-689-7979
Mailing Address - Fax:631-754-1642
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BUILDING 5D
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-689-7979
Practice Address - Fax:631-754-1642
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY8007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00860357Medicaid
NYV49801Medicare ID - Type Unspecified