Provider Demographics
NPI:1316956352
Name:LYNCH, MICHELLE LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:ZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4715 VIEWRIDGE AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1680
Mailing Address - Country:US
Mailing Address - Phone:800-257-8715
Mailing Address - Fax:800-819-1655
Practice Address - Street 1:100 LITTLE DR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3345
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014192900001Medicaid
PA095107MLGMedicare ID - Type Unspecified