Provider Demographics
NPI:1417232034
Name:LYONS, JILL W (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:W
Last Name:LYONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1819
Mailing Address - Country:US
Mailing Address - Phone:716-807-3707
Mailing Address - Fax:716-807-3701
Practice Address - Street 1:1500 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120
Practice Address - Country:US
Practice Address - Phone:716-807-3707
Practice Address - Fax:716-807-3701
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586101041S0200X
NY084044-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool