Provider Demographics
NPI:1982916656
Name:SORENSON, LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SORENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:BRIMHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4061 E DES MOINES ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6231
Mailing Address - Country:US
Mailing Address - Phone:480-447-7073
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:811 S HAMILTON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6308
Practice Address - Country:US
Practice Address - Phone:480-344-6100
Practice Address - Fax:480-344-6101
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-152651041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ984595Medicaid