Healthcare Provider Details

I. General information

NPI: 1174747364
Provider Name (Legal Business Name): DONNA STORM-LYNCH MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SUNNYSIDE BLVD. SUITE F
PLAINVIEW NY
11803-1517
US

IV. Provider business mailing address

54 SUNNYSIDE BLVD. SUITE F
PLAINVIEW NY
11803-1517
US

V. Phone/Fax

Practice location:
  • Phone: 516-349-0355
  • Fax: 516-349-8680
Mailing address:
  • Phone: 516-349-0355
  • Fax: 516-349-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR039219-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4381596
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerAETNA
# 2
IdentifierN76811
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE
# 3
Identifier055528
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVALUE OPTIONS
# 4
Identifier3696
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBEACON HEALTH
# 5
Identifier7403030
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: