1073289971 NPI number — KATHLEEN M LYONS LLC

Table of content: (NPI 1073289971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073289971 NPI number — KATHLEEN M LYONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN M LYONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073289971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CANTER BROOK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HAMILTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01982-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-572-0788
Provider Business Mailing Address Fax Number:
844-222-4840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 WILLOW ST BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HAMILTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01982-2255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-572-0788
Provider Business Practice Location Address Fax Number:
844-222-4840
Provider Enumeration Date:
08/19/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LYONS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
978-572-0788

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)