Provider Demographics
NPI:1306052725
Name:LYONS, LAURENA MACDOUGALL (MED, LMFT)
Entity type:Individual
Prefix:MS
First Name:LAURENA
Middle Name:MACDOUGALL
Last Name:LYONS
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2908
Mailing Address - Country:US
Mailing Address - Phone:617-846-9104
Mailing Address - Fax:
Practice Address - Street 1:213 PAULINE ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2300
Practice Address - Country:US
Practice Address - Phone:617-846-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1195106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist