Provider Demographics
NPI:1134187222
Name:LYONS, SUSIE EILEEN (LCSW, AP)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:EILEEN
Last Name:LYONS
Suffix:
Gender:F
Credentials:LCSW, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358431
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-8431
Mailing Address - Country:US
Mailing Address - Phone:352-339-3520
Mailing Address - Fax:
Practice Address - Street 1:4474 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2216
Practice Address - Country:US
Practice Address - Phone:352-335-9329
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62821041C0700X
FLAP1820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered171100000XOther Service ProvidersAcupuncturist