MEDICARE: MOLLY CAITLIN LYNCH LCSW

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	104100000X	Social Worker	256850	KY
2	1041C0700X	Clinical Social Worker	013986	CT

General Provider Information

NPI Number	:	1760105597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY CAITLIN LYNCH LCSW

Provider Business Mailing Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20415 GULF VICTORY WAY
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79918-8066
Country	:	US
Telephone Number	:	585-281-8769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	08/12/2024

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