Provider Demographics
NPI:1184848665
Name:LYSNE, ROBIN HEERENS (MA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:HEERENS
Last Name:LYSNE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LOPEZ
Other - Last Name:LYSNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:335 EAST LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076
Mailing Address - Country:US
Mailing Address - Phone:831-728-6445
Mailing Address - Fax:
Practice Address - Street 1:335 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-728-6445
Practice Address - Fax:831-761-6011
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184848665OtherSUBSTANCE ABUSE COUNSELOR