Provider Demographics
NPI:1023778560
Name:BECOURTNEY, LYLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:
Last Name:BECOURTNEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4305
Mailing Address - Country:US
Mailing Address - Phone:917-968-0965
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4305
Practice Address - Country:US
Practice Address - Phone:917-968-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist