Provider Demographics
NPI:1821179334
Name:LYON, JASON C (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:LYON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 HUNTINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916
Mailing Address - Country:US
Mailing Address - Phone:401-965-7340
Mailing Address - Fax:
Practice Address - Street 1:42 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1925
Practice Address - Country:US
Practice Address - Phone:401-965-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical