Provider Demographics
NPI:1639942063
Name:LYERLY, STEPHANIE C
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:LYERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3C JAMESTOWN CT
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-3619
Mailing Address - Country:US
Mailing Address - Phone:934-451-9093
Mailing Address - Fax:
Practice Address - Street 1:3C JAMESTOWN CT
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-3619
Practice Address - Country:US
Practice Address - Phone:934-451-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator