Healthcare Provider Details

I. General information

NPI: 1225943574
Provider Name (Legal Business Name): JESSICA LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESS LYNCH

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 9TH ST
BROOKLYN NY
11215-3108
US

IV. Provider business mailing address

715 OCEAN PKWY APT 1A
BROOKLYN NY
11230-7815
US

V. Phone/Fax

Practice location:
  • Phone: 929-373-3568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberP138229-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: