Provider Demographics
NPI:1821364746
Name:LYONS, CARIDAD AMPARO
Entity Type:Individual
Prefix:MS
First Name:CARIDAD
Middle Name:AMPARO
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHACHI
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2545 GRAMERCY DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-1939
Mailing Address - Country:US
Mailing Address - Phone:386-801-8879
Mailing Address - Fax:
Practice Address - Street 1:2545 GRAMERCY DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-1939
Practice Address - Country:US
Practice Address - Phone:386-801-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health