Doctor Name: | LYNDON VINCENT |
NPI Number: | 1063708543 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 434 Warren St Dorchester, MA - 021211325 |
Business Phone Number: | 6175416859 |
Business Fax Number: | |
Mailing Address: | 1 Gardner St Apt 25, ROXBURY |
State: | MA |
Postal Code: | 021191564 |
Phone Number: | 6175410615 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2011 |
NPI Last Update Date: | 06/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |