Provider Demographics
NPI:1548549926
Name:CERAR, LYNNE M (LCSW)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:CERAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:ARK
Mailing Address - State:VA
Mailing Address - Zip Code:23003-0269
Mailing Address - Country:US
Mailing Address - Phone:804-693-5640
Mailing Address - Fax:804-693-4822
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572-0729
Practice Address - Country:US
Practice Address - Phone:804-333-3671
Practice Address - Fax:804-333-3657
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040077051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA294721OtherVALUE OPTIONS
VA1497717615OtherVA PREMIER
VA1497717615Medicaid