MEDICARE: LYNN M CORBETT BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	156	MA
2	101YM0800X	Mental Health Counselor	5086	MA

General Provider Information

NPI Number	:	1417251737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN M CORBETT BCBA

Provider Business Mailing Address
First Line	:	749 ROCKY HILL RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-5523
Country	:	US
Telephone Number	:	774-269-8028
Fax Number	:	508-224-9823

Provider Business Practice Location Address
First Line	:	749 ROCKY HILL RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-5523
Country	:	US
Telephone Number	:	508-280-7592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2010
Last Update Date	:	06/21/2023

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