Provider Demographics
NPI:1669525077
Name:PERSSON, LYNN K (MS)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:K
Last Name:PERSSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4760
Mailing Address - Country:US
Mailing Address - Phone:203-874-1781
Mailing Address - Fax:
Practice Address - Street 1:215 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4760
Practice Address - Country:US
Practice Address - Phone:203-874-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT240000279CT01OtherANTHEM BC & BS PROV. NO.
CT283586OtherMHN PROVIDER NUMBER