Basic Information
| Provider Information | |||||||||
| NPI: | 1053894345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | LARA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 ACORN DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454192334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134981060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 57 REGIONAL DR STE 7 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033018518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032247630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2018 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.