Healthcare Provider Details

I. General information

NPI: 1396024808
Provider Name (Legal Business Name): GALE E LYNCH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 E 101ST ST
CLEVELAND OH
44106-4110
US

IV. Provider business mailing address

1909 E 101ST ST
CLEVELAND OH
44106-4110
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-8118
  • Fax: 216-791-1101
Mailing address:
  • Phone: 216-791-8118
  • Fax: 216-791-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS-1957
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: