Lynne Ann Modzelesky, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6144 Issued in NC

Practice address

3404 Black Tower CT
Fayetteville, NC 28306-8097

Phone

(610) 425-0752

Fax

(707) 253-5097

NPI assigned

Nov 25, 2014

Last updated

Apr 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Lynne Ann Flores Former name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1295132975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 NAPA VALLEJO HWY.",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945586293",
            "telephone_number": "707-253-5654",
            "fax_number": "707-253-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3404 BLACK TOWER CT",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283068097",
            "telephone_number": "610-425-0752",
            "fax_number": "707-253-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODZELESKY",
        "first_name": "LYNNE",
        "middle_name": "ANN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-25",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "29009",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS017705",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "6144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYNNE",
            "last_name": "FLORES",
            "middle_name": "ANN",
            "credential": "PSYD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Brittany Taylor Moesch, CCC-SLP
• Omair Mohamed
• Mohammad a Sabur Nasiri
• Felipe Jungblut Mohr, DDS
• William C Molair, MD

• Clinical Psychologist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.