Provider Demographics
NPI:1871340786
Name:LYNCH, CASEY JACQUELINE (MED)
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:JACQUELINE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-4964
Mailing Address - Country:US
Mailing Address - Phone:774-327-9365
Mailing Address - Fax:
Practice Address - Street 1:160 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3919
Practice Address - Country:US
Practice Address - Phone:508-296-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health