Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY5673 | FL |
Y | 103T00000X | Psychologist | PY5673 | FL |
NPI | 1003204777 |
---|---|
Provider Name | Eileen Lyons |
First Address | Estero, FL 33928-3218 |
Second Address | Estero, FL 33928-3218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2015 |
Last Update Date | 05/01/2015 |