Healthcare Provider Details

I. General information

NPI: 1568029478
Provider Name (Legal Business Name): LYNN ADRIENNE FRUNZI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18227 CLEAR LAKE DR
LUTZ FL
33548-6436
US

IV. Provider business mailing address

18227 CLEAR LAKE DR
LUTZ FL
33548-6436
US

V. Phone/Fax

Practice location:
  • Phone: 732-778-3462
  • Fax:
Mailing address:
  • Phone: 732-778-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: