Provider Demographics
NPI:1083338073
Name:LYON, ERIN DAWN (LMSW, MA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DAWN
Last Name:LYON
Suffix:
Gender:F
Credentials:LMSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2007
Mailing Address - Country:US
Mailing Address - Phone:585-286-7559
Mailing Address - Fax:
Practice Address - Street 1:21 WILLOW POND WAY STE 103
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-385-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111492-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker