Provider Demographics
NPI:1841341989
Name:LYONS, LISA (PH D)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1333
Mailing Address - Country:US
Mailing Address - Phone:201-947-5558
Mailing Address - Fax:201-944-0854
Practice Address - Street 1:175 CEDAR LANE
Practice Address - Street 2:SUITE # 8
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-947-5558
Practice Address - Fax:201-944-0854
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3767103T00000X
NY013106103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV91251Medicare ID - Type Unspecified
NJ009747Medicare ID - Type Unspecified