Basic Information
| Provider Information | |||||||||
| NPI: | 1558449967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAVIGAN | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSWC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2336 GODDARD PARKWAY | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346961 | ||||||||
| FaxNumber: | 4103346960 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 RIVERSIDE DR STE B101 | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218014701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439788688 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 10/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 09611 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 522156095 | 01 | MD | UNITED BEHAVIORAL HEALTH | OTHER | LM49EA | 01 | MD | CAREFIRST BCBS GROUP | OTHER | 259147000 | 01 | MD | MAGELLAN GROUP | OTHER | 517251 | 01 | UHC MAMSI GROUP# | OTHER | 0001 | 01 | CAREFIRST FEDERAL PIN | OTHER | 81030602 | 01 | MD | CAREFIRST BCBS PIN | OTHER | R968 | 01 | CAREFIRST FEDERAL GROUP | OTHER | 724332 | 01 | NCPPO PIN | OTHER | PVPB127119 | 01 | AMERICAN PSYCH SYSTEM | OTHER | 2104268 | 01 | UNITED HEALTH CARE MAMSI | OTHER | 229696000 | 01 | MD | MAGELLAN PIN | OTHER | 5221560950002 | 01 | TRICARE | OTHER |