Provider Demographics
NPI:1548258593
Name:JONES, LYNDON C (LICSW)
Entity type:Individual
Prefix:
First Name:LYNDON
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966A PARK ST
Mailing Address - Street 2:STE 4
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0516
Mailing Address - Country:US
Mailing Address - Phone:781-341-0923
Mailing Address - Fax:781-341-0994
Practice Address - Street 1:966A PARK ST
Practice Address - Street 2:STE 4
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-0516
Practice Address - Country:US
Practice Address - Phone:781-341-0923
Practice Address - Fax:781-341-0994
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107300103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07037Medicare ID - Type Unspecified