MEDICARE: KAITLYNNE ROSE LYNCH LCSWA

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	P019101	NC

General Provider Information

NPI Number	:	1790460780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYNNE ROSE LYNCH LCSWA

Provider Business Mailing Address
First Line	:	200 E 2ND AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4358
Country	:	US
Telephone Number	:	704-874-1904
Fax Number	:	704-865-4614

Provider Business Practice Location Address
First Line	:	409 W SUMTER ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4326
Country	:	US
Telephone Number	:	704-476-8399
Fax Number	:	704-476-8316

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	12/17/2025

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