Provider Demographics
NPI:1275381535
Name:LYONS, CAMILLE NATASHA (CASAC- T)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:NATASHA
Last Name:LYONS
Suffix:
Gender:F
Credentials:CASAC- T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5216
Mailing Address - Country:US
Mailing Address - Phone:347-869-0322
Mailing Address - Fax:
Practice Address - Street 1:1393 OHIO AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5216
Practice Address - Country:US
Practice Address - Phone:347-869-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)