Provider Demographics
NPI:1609383181
Name:LYON, LIONEL S (PSYD)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:S
Last Name:LYON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ATHELSTANE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2419
Mailing Address - Country:US
Mailing Address - Phone:617-875-0606
Mailing Address - Fax:
Practice Address - Street 1:101 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3001
Practice Address - Country:US
Practice Address - Phone:617-875-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3084103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist