Healthcare Provider Details

I. General information

NPI: 1073959318
Provider Name (Legal Business Name): ANDREA HURLEY-LYNCH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4409
  • Fax: 716-278-4416
Mailing address:
  • Phone: 716-278-4409
  • Fax: 716-278-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: