Provider Demographics
NPI:1912926122
Name:MATHERNE, LYNN M (PHD,)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:MARY
Other - Last Name:MATHERNE-CORRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:343 LARCHMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4272
Mailing Address - Country:US
Mailing Address - Phone:210-380-0397
Mailing Address - Fax:210-816-5900
Practice Address - Street 1:343 LARCHMONT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4272
Practice Address - Country:US
Practice Address - Phone:210-829-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23787103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172854501Medicaid
TX8B5937Medicare PIN
TX172854501Medicaid