Provider Demographics
NPI:1215314992
Name:TRAVERSIERE, LYONEL
Entity type:Individual
Prefix:MR
First Name:LYONEL
Middle Name:
Last Name:TRAVERSIERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 ALTHEA RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2950
Mailing Address - Country:US
Mailing Address - Phone:617-602-5498
Mailing Address - Fax:
Practice Address - Street 1:58 ALTHEA RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2950
Practice Address - Country:US
Practice Address - Phone:617-602-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor