Provider Demographics
NPI:1043469463
Name:O'TOOLE-LYON, ERIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:O'TOOLE-LYON
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 1:2514 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7808
Mailing Address - Country:US
Mailing Address - Phone:804-255-9289
Mailing Address - Fax:
Practice Address - Street 1:2514 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7808
Practice Address - Country:US
Practice Address - Phone:804-255-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040069181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945255Medicaid
VA47-2056204OtherIRS