Provider Demographics
NPI:1588902209
Name:COREY, LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:COREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MOUNTAIN AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1737
Mailing Address - Country:US
Mailing Address - Phone:201-805-0714
Mailing Address - Fax:
Practice Address - Street 1:140 MOUNTAIN AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1737
Practice Address - Country:US
Practice Address - Phone:201-805-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052470001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical