Individual provider Active NPI

Judith R Lynch, LCSW

  • Counselor
  • Cortland, NY
National Provider Identifier
1770867483
Registry record updated Aug 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
085401 Issued in NY
Practice address
165 Main St Ste a
Cortland, NY 13045
Phone
(607) 753-0234
NPI assigned
Sep 30, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 085401 NY Primary

Addresses

Primary practice location

165 Main St Ste a
Cortland, NY 13045

Mailing address

16 Kimberly Dr
Dryden, NY 13053-9728
Phone (716) 969-0404

Other practice location 1

10 N Main St
Cortland, NY 13045-2130
Phone (607) 753-0234

Other practice location 2

408 W State St
Ithaca, NY 14850-5220
Phone (716) 969-0404

Other practice location 3

10 N Main St
Cortland, NY 13045-2130
Phone (607) 753-0234

Other identifiers 1

IdentifierTypeStateIssuer
1336163963MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170803000891 NY Practitioner - Clinical Social Worker 6204107600 Practice locations: Ithaca, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

408 W State St
Ithaca, NY 14850-5220
Phone (607) 216-8050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085401NYMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Court Street Chiropractic of Ithaca, P.C. Past Accepting new patients
Court St. Chiropractic of Ithaca, P.C. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1770867483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 KIMBERLY DR",
            "city": "DRYDEN",
            "state": "NY",
            "postal_code": "130539728",
            "telephone_number": "716-969-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 MAIN ST STE A",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "13045",
            "telephone_number": "607-753-0234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 N Main St",
            "address_purpose": "LOCATION",
            "city": "Cortland",
            "state": "NY",
            "postal_code": "130452130",
            "country_code": "US",
            "telephone_number": "607-753-0234",
            "fax_number": "607-299-4349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "408 W State St",
            "address_purpose": "LOCATION",
            "city": "Ithaca",
            "state": "NY",
            "postal_code": "148505220",
            "country_code": "US",
            "telephone_number": "716-969-0404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 N Main St",
            "address_purpose": "LOCATION",
            "city": "Cortland",
            "state": "NY",
            "postal_code": "130452130",
            "country_code": "US",
            "telephone_number": "607-753-0234",
            "fax_number": "607-299-4349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYNCH",
        "first_name": "JUDITH",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-30",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": "085401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336163963",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cortland, NY

Sources for this page

Verify at the official NPI Registry.