Provider Demographics
NPI:1952547382
Name:LYNCH, KELLY ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY ANNE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 QUARRY VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2001
Mailing Address - Country:US
Mailing Address - Phone:860-856-1696
Mailing Address - Fax:860-920-5222
Practice Address - Street 1:56 CENTER STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2537
Practice Address - Country:US
Practice Address - Phone:860-856-1696
Practice Address - Fax:860-920-5222
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical