Provider Demographics
NPI:1841300969
Name:KEGLEY, LYNN M (LICSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:KEGLEY
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 1:154 BROAD ST STE 1511
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-3205
Mailing Address - Country:US
Mailing Address - Phone:603-577-5551
Mailing Address - Fax:603-577-5576
Practice Address - Street 1:154 BROAD ST STE 1511
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3205
Practice Address - Country:US
Practice Address - Phone:603-577-5551
Practice Address - Fax:603-577-5576
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423693Medicaid
NH30423693Medicaid
6018863OtherMVP
5346402OtherFIRST HEALTH