Provider Demographics
NPI:1952065708
Name:FIELD, LYRIC
Entity Type:Individual
Prefix:
First Name:LYRIC
Middle Name:
Last Name:FIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631280
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1280
Mailing Address - Country:US
Mailing Address - Phone:610-864-7376
Mailing Address - Fax:877-599-3340
Practice Address - Street 1:3744 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3224
Practice Address - Country:US
Practice Address - Phone:610-864-7376
Practice Address - Fax:877-599-3340
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-21-164136106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician