Provider Demographics
NPI:1912505967
Name:CLOUTIER, LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:CLOUTIER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2695
Mailing Address - Country:US
Mailing Address - Phone:315-464-3265
Mailing Address - Fax:315-464-3282
Practice Address - Street 1:719 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2695
Practice Address - Country:US
Practice Address - Phone:315-464-3265
Practice Address - Fax:315-464-3282
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023915103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical