Provider Demographics
NPI:1538368022
Name:LYNN, ANTOINETTE J (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:J
Last Name:LYNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1Q
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6547
Mailing Address - Country:US
Mailing Address - Phone:212-666-3180
Mailing Address - Fax:
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:SUITE 1Q
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-666-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9539103G00000X, 103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral