MEDICARE: NICOLE A LYNCH LSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1932605334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE A LYNCH LSW

Provider Business Mailing Address
First Line	:	3073 ENGLISH CREEK AVE STE 3
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-9711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3073 ENGLISH CREEK AVE STE 3
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-9711
Country	:	US
Telephone Number	:	609-569-0239
Fax Number	:	609-569-1942

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

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/04/2018

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