Provider Demographics
NPI:1295379238
Name:LYONS, KATHLEEN M (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:LYONS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CANTER BROOK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-5200
Mailing Address - Country:US
Mailing Address - Phone:978-314-0733
Mailing Address - Fax:
Practice Address - Street 1:205 WILLOW ST BLDG B
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2255
Practice Address - Country:US
Practice Address - Phone:978-572-0788
Practice Address - Fax:844-222-4840
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1232081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical