Healthcare Provider Details

I. General information

NPI: 1134561210
Provider Name (Legal Business Name): LYNN DIANE GRYCHOWSKI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN DIANE STANCLIFF L.S.W.

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 LANCASTER ROAD
ERIE PA
16506-5271
US

IV. Provider business mailing address

4301 LANCASTER ROAD
ERIE PA
16506-5271
US

V. Phone/Fax

Practice location:
  • Phone: 814-836-6321
  • Fax: 814-836-6311
Mailing address:
  • Phone: 814-836-6321
  • Fax: 814-836-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 010492L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: