Provider Demographics
NPI:1679600795
Name:LYNCH, PATRICIA KATHLEEN (LICSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KATHLEEN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 1ST AVE SW
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3383
Mailing Address - Country:US
Mailing Address - Phone:507-289-5110
Mailing Address - Fax:507-281-5335
Practice Address - Street 1:421 1ST AVE SW
Practice Address - Street 2:SUITE 200E
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3383
Practice Address - Country:US
Practice Address - Phone:507-289-5110
Practice Address - Fax:507-281-5335
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN177041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN044600900Medicaid
MN921001045655OtherPREFERRED ONE
MN137050OtherUCARE
MNHP58827OtherHEALTHPARTNERS
MN83G10LYOtherBCBS OF MN
MN62-68292OtherUNITED BEHAVIORAL HEALTH
MN044600900Medicaid