Provider Demographics
NPI:1982855151
Name:LYONS-FADEL, MICHELLE S (MSS, LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:LYONS-FADEL
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 STENTON AVE.
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3245
Mailing Address - Country:US
Mailing Address - Phone:215-641-5835
Mailing Address - Fax:215-247-5175
Practice Address - Street 1:7600 STENTON AVE.
Practice Address - Street 2:STE 1F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3245
Practice Address - Country:US
Practice Address - Phone:215-247-5400
Practice Address - Fax:215-247-5175
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW008269L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA600535191OtherMAGELLAN