Provider Demographics
NPI:1902683683
Name:LYONS, KIRSTEN MARGARET (LSW, MED)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MARGARET
Last Name:LYONS
Suffix:
Gender:F
Credentials:LSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 PINE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1613
Mailing Address - Country:US
Mailing Address - Phone:717-817-1201
Mailing Address - Fax:
Practice Address - Street 1:4928 PINE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1613
Practice Address - Country:US
Practice Address - Phone:717-817-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1388151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical