Provider Demographics
NPI:1649570276
Name:LYLE, PAMELA JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JANE
Last Name:LYLE
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 1:10 PRESTIGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-1055
Mailing Address - Country:US
Mailing Address - Phone:518-386-4366
Mailing Address - Fax:
Practice Address - Street 1:10 PRESTIGE PKWY
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-1055
Practice Address - Country:US
Practice Address - Phone:518-386-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730442221041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool