Provider Demographics
NPI:1023532074
Name:CORY, LYNDSIE ELIZABETH (LYNDSIE CORY, MA)
Entity type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:ELIZABETH
Last Name:CORY
Suffix:
Gender:F
Credentials:LYNDSIE CORY, MA
Other - Prefix:
Other - First Name:LYNDSIE
Other - Middle Name:ELIZABETH
Other - Last Name:CORY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LYNDSIE CORY, MA
Mailing Address - Street 1:5721 BENTGRASS DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2699
Mailing Address - Country:US
Mailing Address - Phone:727-688-3252
Mailing Address - Fax:
Practice Address - Street 1:5763 ROSIN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-4401
Practice Address - Country:US
Practice Address - Phone:941-375-4321
Practice Address - Fax:941-822-0361
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH16036101YM0800X
FLIMT2729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health