Provider Demographics
NPI:1770784415
Name:LYNN, EDMUND RUSSELL JR (LCSW LICSW)
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:RUSSELL
Last Name:LYNN
Suffix:JR
Gender:M
Credentials:LCSW LICSW
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Mailing Address - Street 1:3069 S WOODROW ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2114
Mailing Address - Country:US
Mailing Address - Phone:703-903-9696
Mailing Address - Fax:703-821-2505
Practice Address - Street 1:6033 LITTLE FALLS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207
Practice Address - Country:US
Practice Address - Phone:703-903-9696
Practice Address - Fax:703-821-2505
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0904002802LCSW1041C0700X
DCLC0300900LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904002802OtherLCSW
DCLC0300900OtherLICSW