1790774735 NPI number — MS. VERONICA ROSETTA LYNCH LCSW

Table of content: MS. VERONICA ROSETTA LYNCH LCSW (NPI 1790774735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790774735 NPI number — MS. VERONICA ROSETTA LYNCH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNCH
Provider First Name:
VERONICA
Provider Middle Name:
ROSETTA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1790774735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 WILLOUGHBY AVE
Provider Second Line Business Mailing Address:
STE 413
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11205-3843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-783-1033
Provider Business Mailing Address Fax Number:
718-783-1033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 WILLOUGHBY AVE
Provider Second Line Business Practice Location Address:
STE 413
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11205-3843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-526-5116
Provider Business Practice Location Address Fax Number:
718-783-1033
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R033364 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01563088 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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