Healthcare Provider Details

I. General information

NPI: 1770706178
Provider Name (Legal Business Name): LYNNE C DAVIS LSW LMFT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 LOCKE HILL RD
WENDELL MA
01379-7927
US

IV. Provider business mailing address

PO BOX 942
WENDELL MA
01379
US

V. Phone/Fax

Practice location:
  • Phone: 978-544-2067
  • Fax:
Mailing address:
  • Phone: 978-544-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number405
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3105548
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number250
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: