Provider Demographics
NPI:1356756456
Name:LYONS, JANE CLEMONS (LCSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:CLEMONS
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 1:380 FORMOSA DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3042
Mailing Address - Country:US
Mailing Address - Phone:321-243-9136
Mailing Address - Fax:
Practice Address - Street 1:380 FORMOSA DR
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3042
Practice Address - Country:US
Practice Address - Phone:321-243-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical