Provider Demographics
NPI:1194750281
Name:DEAN, LYNN DOROTHY (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:DOROTHY
Last Name:DEAN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CORNWALL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3332
Mailing Address - Country:US
Mailing Address - Phone:732-613-9550
Mailing Address - Fax:732-613-9559
Practice Address - Street 1:4 CORNWALL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3332
Practice Address - Country:US
Practice Address - Phone:732-613-9550
Practice Address - Fax:732-613-9559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001977001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ150625Medicare ID - Type UnspecifiedSOCIAL WORKER