Provider Demographics
NPI:1972321057
Name:LYNCH, MELISSA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:LYNCH
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 1:7335 E LAMPKINS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8675
Mailing Address - Country:US
Mailing Address - Phone:812-369-2215
Mailing Address - Fax:
Practice Address - Street 1:7335 E LAMPKINS RIDGE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8675
Practice Address - Country:US
Practice Address - Phone:812-369-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011448A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical