Provider Demographics
NPI:1316070964
Name:KILROY, LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:KILROY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 OCEAN PARK BLVD # 145
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3004
Mailing Address - Country:US
Mailing Address - Phone:310-446-0888
Mailing Address - Fax:
Practice Address - Street 1:3101 5TH ST APT 8
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5650
Practice Address - Country:US
Practice Address - Phone:310-880-6778
Practice Address - Fax:310-314-2228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 15015OtherLICENSE NUMBER