Provider Demographics
NPI:1871747261
Name:ANDERSON, LYNNETTE CAROLYN (MS)
Entity type:Individual
Prefix:MS
First Name:LYNNETTE
Middle Name:CAROLYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MERRIBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2717
Mailing Address - Country:US
Mailing Address - Phone:215-313-0593
Mailing Address - Fax:
Practice Address - Street 1:1601 MERRIBROOK LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2717
Practice Address - Country:US
Practice Address - Phone:215-313-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)