Provider Demographics
NPI:1336203611
Name:LYONS, ANN DOROTHY (LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:DOROTHY
Last Name:LYONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 LEXINGTON AVE
Mailing Address - Street 2:APT 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1426
Mailing Address - Country:US
Mailing Address - Phone:212-744-7999
Mailing Address - Fax:212-744-7990
Practice Address - Street 1:1200 LEXINGTON AVE
Practice Address - Street 2:APT 3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1426
Practice Address - Country:US
Practice Address - Phone:212-744-7999
Practice Address - Fax:212-744-7990
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR008869-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN09501Medicare ID - Type Unspecified