Provider Demographics
NPI:1730872425
Name:LYNCH, SHANAE MONIQUE (LMSW)
Entity type:Individual
Prefix:MS
First Name:SHANAE
Middle Name:MONIQUE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1700
Mailing Address - Country:US
Mailing Address - Phone:203-368-4291
Mailing Address - Fax:
Practice Address - Street 1:475 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1700
Practice Address - Country:US
Practice Address - Phone:203-368-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5896104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker