Provider Demographics
NPI:1407120850
Name:LYONS, KEITH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
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:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0090
Mailing Address - Country:US
Mailing Address - Phone:516-730-6124
Mailing Address - Fax:
Practice Address - Street 1:555 BROADHOLLOW ROAD
Practice Address - Street 2:SUITE 216
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:516-730-6124
Practice Address - Fax:631-759-2708
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR075006-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical