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General NPI Number Information
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NPI Number | 1245045467
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Entity Type | Organization
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Legal Business Name | BEYOND THE PINES LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 4 CHERYL AVE
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City | WALLINGFORD
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State | CT
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Zip | 06492-3911
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Country | US
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Telephone | 203-589-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CHERYL AVE
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City | WALLINGFORD
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State | CT
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Zip | 06492-3911
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Country | US
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Telephone | 203-589-3532
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MRS. KATIE ELIZABETH LYNCH
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Credential | LCSW, MA
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Telephone | 203-589-3432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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