Healthcare Provider Details

I. General information

NPI: 1831214311
Provider Name (Legal Business Name): JOHN ROBERT LYNCH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 STAPLES MILL RD
RICHMOND VA
23228-5427
US

IV. Provider business mailing address

309 W FRANCIS ST
ASHLAND VA
23005-1945
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-0966
  • Fax: 804-264-1029
Mailing address:
  • Phone: 804-264-0966
  • Fax: 804-264-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: