Provider Demographics
NPI:1770691594
Name:BURNS, LYNN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:BURNS
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 1:216 N LINCOLN WAY
Mailing Address - Street 2:SUITE 30
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-1715
Mailing Address - Country:US
Mailing Address - Phone:916-995-6201
Mailing Address - Fax:
Practice Address - Street 1:216 N LINCOLN WAY
Practice Address - Street 2:SUITE 30
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-1715
Practice Address - Country:US
Practice Address - Phone:916-995-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS135371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1204Medicaid