Provider Demographics
NPI:1821203712
Name:LYALL, VICKI LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNN
Last Name:LYALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GORWIN DR
Mailing Address - Street 2:PO BOX 367
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-1309
Mailing Address - Country:US
Mailing Address - Phone:781-293-4564
Mailing Address - Fax:781-293-4564
Practice Address - Street 1:7 GORWIN DR
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-1309
Practice Address - Country:US
Practice Address - Phone:781-293-4564
Practice Address - Fax:781-293-4564
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3052103TC0700X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic