Provider Demographics
NPI:1386776979
Name:EDGERLY, LYNN (LCSW R)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:EDGERLY
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GLEN ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3578
Mailing Address - Country:US
Mailing Address - Phone:518-321-9280
Mailing Address - Fax:518-615-5803
Practice Address - Street 1:333 GLEN ST STE 100A
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3578
Practice Address - Country:US
Practice Address - Phone:518-321-9280
Practice Address - Fax:518-615-5803
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR06332211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB6587Medicare PIN
NYBA1233Medicare PIN