Healthcare Provider Details

I. General information

NPI: 1467134429
Provider Name (Legal Business Name): LYNSENE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19650 CLUB HOUSE RD STE 202-A
MONTGOMERY VILLAGE MD
20886-3003
US

IV. Provider business mailing address

10440 CARLYN RIDGE RD
DAMASCUS MD
20872-2157
US

V. Phone/Fax

Practice location:
  • Phone: 301-337-9642
  • Fax:
Mailing address:
  • Phone: 301-337-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LYDIA OPARA
Title or Position: OWNER
Credential:
Phone: 301-337-9642