Heather Lynch, PSYCHOLOGIST-MASTER
Individual provider Active NPI Clinical Psychologist · South Burlington, VT
NPI 1053647693 · NPPES record last updated Apr 12, 2010
Key facts
- NPI
- 1053647693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 047.0045057 (VT)
- Practice address
- 34 Patchen Rd
South Burlington, VT 05403-5704 - Phone
- (802) 343-1701
- NPI assigned
- Nov 1, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047.0045057 | VT | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 047.0045057 | VT | Yes |
Addresses
Primary practice location
34 Patchen Rd
South Burlington, VT 05403-5704
Mailing address
PO Box 4635
Burlington, VT 05406-4635
Phone (802) 343-1701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1017144 | Medicaid | VT |
NPI Registry JSON
{
"created_epoch": "1257033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271030400000",
"number": "1053647693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4635",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054064635",
"telephone_number": "802-343-1701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 PATCHEN RD",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054035704",
"telephone_number": "802-343-1701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYNCH",
"first_name": "HEATHER",
"credential": "PSYCHOLOGIST-MASTER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-01",
"last_updated": "2010-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": "047.0045057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1017144",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Burlington, VT
- Lund Family Center, Inc.
- Christopher L Lundberg
- Christopher J Lupariello
- Luxottica of America Inc.
- Luxottica Retail North America Inc
- Mary Lynch
- Leah Mariette Macaulay
- Mali Macconnell
- Allison Catherine Mack
- Patrick Joseph Mahoney
All providers in South Burlington, VT · Clinical Psychologist in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.