Provider Demographics
NPI:1780767038
Name:LYNES, CAROLYN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:LYNES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM HGTS
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:STE G05
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2721
Practice Address - Country:US
Practice Address - Phone:781-893-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1113111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
703136OtherTUFTS
99618201OtherNETWORK HEALTH
042611055OtherTAX ID
MA1303287OtherMBHP
1004745OtherNHP
MAP10329OtherBCBS
MA1303287Medicaid
MAM18633OtherBCBS
NP10332OtherBOSTON MED
MA1303287OtherMBHP
P23067Medicare UPIN