Provider Demographics
NPI:1730510843
Name:PEARL, LYNNE (CAP, ICADC)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:PEARL
Suffix:
Gender:F
Credentials:CAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 19TH PL
Mailing Address - Street 2:STE. E-2
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0686
Mailing Address - Country:US
Mailing Address - Phone:772-257-5995
Mailing Address - Fax:772-257-5962
Practice Address - Street 1:1705 19TH PL
Practice Address - Street 2:STE. E-2
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0686
Practice Address - Country:US
Practice Address - Phone:772-257-5995
Practice Address - Fax:772-257-5962
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23385101YM0800X
FL101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLADC-003784-2014OtherCAP