1558449967 NPI number — MS. LYNN GAVIGAN LCSWC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558449967 NPI number — MS. LYNN GAVIGAN LCSWC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GAVIGAN

Provider First Name:

LYNN

Provider Middle Name:

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

LCSWC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1558449967

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/31/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2336 GODDARD PARKWAY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SALISBURY

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21801

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-334-6961

Provider Business Mailing Address Fax Number:

410-334-6960

Provider First Line Business Practice Location Address:

560 RIVERSIDE DR STE B101

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SALISBURY

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21801-4701

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

443-978-8688

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

11/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  09611 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 522156095 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: LM49EA . This is a "CAREFIRST BCBS GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 259147000 . This is a "MAGELLAN GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 517251 . This is a "UHC MAMSI GROUP#" identifier . This identifiers is of the category "OTHER".
• Identifier: 0001 . This is a "CAREFIRST FEDERAL PIN" identifier . This identifiers is of the category "OTHER".
• Identifier: 81030602 . This is a "CAREFIRST BCBS PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: R968 . This is a "CAREFIRST FEDERAL GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 724332 . This is a "NCPPO PIN" identifier . This identifiers is of the category "OTHER".
• Identifier: PVPB127119 . This is a "AMERICAN PSYCH SYSTEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 2104268 . This is a "UNITED HEALTH CARE MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 229696000 . This is a "MAGELLAN PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 5221560950002 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".