Provider Demographics
NPI:1306288949
Name:LYNCH, LARA ANN (MED)
Entity type:Individual
Prefix:MISS
First Name:LARA
Middle Name:ANN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 RIVERDALE AVE
Mailing Address - Street 2:5F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6200 RIVERDALE AVE
Practice Address - Street 2:5F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:347-670-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst