Provider Demographics
NPI:1538822051
Name:LYNCH, CANDACE M (MSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55D TIVOLI GDNS
Mailing Address - Street 2:
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5425
Mailing Address - Country:US
Mailing Address - Phone:845-674-2392
Mailing Address - Fax:
Practice Address - Street 1:6339 MILL ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1427
Practice Address - Country:US
Practice Address - Phone:845-871-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14-1397918Medicaid