Provider Demographics
NPI:1457132342
Name:SWITCHBACK PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:SWITCHBACK PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-431-0372
Mailing Address - Street 1:120 W CHURCH ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7813
Mailing Address - Country:US
Mailing Address - Phone:443-431-0372
Mailing Address - Fax:240-324-8856
Practice Address - Street 1:120 W CHURCH ST STE 3A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-7813
Practice Address - Country:US
Practice Address - Phone:443-431-0372
Practice Address - Fax:240-324-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)