Provider Demographics
NPI:1356365811
Name:LYONS, MICHELE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
Last Name:LYONS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:GALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11 MIDSTATE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1882
Mailing Address - Country:US
Mailing Address - Phone:781-474-5256
Mailing Address - Fax:781-551-3396
Practice Address - Street 1:11 MIDSTATE DR STE 3
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1882
Practice Address - Country:US
Practice Address - Phone:781-474-5256
Practice Address - Fax:781-551-3396
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW5104401Medicare UPIN