MEDICARE: KRISTIAN LYNCH, LCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205650496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTIAN LYNCH, LCSW, LLC

Provider Business Mailing Address
First Line	:	244 N WYOMING AVE
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-1600
Country	:	US
Telephone Number	:	917-579-6396
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 KILBURN PL
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2110
Country	:	US
Telephone Number	:	917-579-6396
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KRISTIAN LYNCH
Credential	:	LCSW
Telephone Number	:	917-579-6396

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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