Healthcare Provider Details

I. General information

NPI: 1730316092
Provider Name (Legal Business Name): SUZANNE H LYNAH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 AUSTINE DR BUSINESS OFFICE
BRATTLEBORO VT
05301-6634
US

IV. Provider business mailing address

209 AUSTINE DR BUSINESS OFFICE
BRATTLEBORO VT
05301-6634
US

V. Phone/Fax

Practice location:
  • Phone: 802-258-9500
  • Fax: 802-258-9574
Mailing address:
  • Phone: 802-258-9500
  • Fax: 802-258-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0001186
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: