Provider Demographics
NPI:1386031557
Name:LYONS, ELLEN (LMSW,SIFI)
Entity Type:Individual
Prefix:MR
First Name:ELLEN
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:LMSW,SIFI
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW,SIFI
Mailing Address - Street 1:7701 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2413
Mailing Address - Country:US
Mailing Address - Phone:917-841-1531
Mailing Address - Fax:718-837-5756
Practice Address - Street 1:7701 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2413
Practice Address - Country:US
Practice Address - Phone:917-841-1531
Practice Address - Fax:718-837-5756
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0724141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical