Provider Demographics
NPI:1740293505
Name:CONNELLY, LYNETTE R (LCSW)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:R
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4914
Mailing Address - Country:US
Mailing Address - Phone:410-366-1980
Mailing Address - Fax:410-366-8530
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5355
Practice Address - Country:US
Practice Address - Phone:410-848-7830
Practice Address - Fax:410-876-4791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD066131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD396957OtherTRICARE
MD298638-000OtherMAGELLAN
MD7983549OtherAETNA
MD038119OtherVALUE OPTIONS
MD231252OtherCOMPSYCH
MD257613OtherKAISER
MD284441OtherMAMSI
MD530200500Medicaid
MD2321497000OtherAMERIHEALTH
MD248514OtherUNITED BEHAVORIAL HEALTH
MD887526-01OtherCAREFIRST BCBS
DCT541-0004OtherCAREFIRST BCBS
MDPVPB213077OtherAPS HEALTHCARE
DCT541-0004OtherCAREFIRST BCBS