Provider Demographics
NPI:1881951895
Name:LYMAN, JON ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:ALAN
Last Name:LYMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JEREMIAH LN
Mailing Address - Street 2:
Mailing Address - City:PITTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08867-5168
Mailing Address - Country:US
Mailing Address - Phone:908-892-6903
Mailing Address - Fax:
Practice Address - Street 1:67 BEAVER AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3071
Practice Address - Country:US
Practice Address - Phone:908-892-6903
Practice Address - Fax:908-238-0067
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-15
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool