Provider Demographics
NPI:1821203258
Name:LYONS, KATHLEEN STELLA (MED, CAES)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:STELLA
Last Name:LYONS
Suffix:
Gender:F
Credentials:MED, CAES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 UPLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-2129
Mailing Address - Country:US
Mailing Address - Phone:508-748-1457
Mailing Address - Fax:508-291-3538
Practice Address - Street 1:11 UPLAND WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-2129
Practice Address - Country:US
Practice Address - Phone:508-748-1457
Practice Address - Fax:508-291-3538
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA320103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool