Provider Demographics
NPI:1679139232
Name:LYON, CAITLIN VICTORIA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:VICTORIA
Last Name:LYON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:VICTORIA
Other - Last Name:REBENACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 RIDGE RUNNER RD
Mailing Address - Street 2:
Mailing Address - City:WARDENSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26851-8366
Mailing Address - Country:US
Mailing Address - Phone:304-867-9663
Mailing Address - Fax:
Practice Address - Street 1:125 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4732
Practice Address - Country:US
Practice Address - Phone:540-770-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040112561041C0700X
WVDP009451101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical