Provider Demographics
NPI:1619068749
Name:GRASSO-LYON, PAMELA JEAN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:GRASSO-LYON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:GRASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:23 RAILROAD AVE
Mailing Address - Street 2:SUITE #9
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1858
Mailing Address - Country:US
Mailing Address - Phone:781-592-2797
Mailing Address - Fax:781-592-2787
Practice Address - Street 1:23 RAILROAD AVE
Practice Address - Street 2:SUITE #9
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1858
Practice Address - Country:US
Practice Address - Phone:781-592-2797
Practice Address - Fax:781-592-2787
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0853OtherBCBSMA PROVIDER NUMBER