Provider Demographics
NPI:1306139068
Name:LYLE, BETTY ANN (LSW)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:ANN
Last Name:LYLE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31523 PORTLAND MILLS RD
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-3711
Mailing Address - Country:US
Mailing Address - Phone:814-772-4648
Mailing Address - Fax:
Practice Address - Street 1:31523 PORTLAND MILLS RD
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-3711
Practice Address - Country:US
Practice Address - Phone:814-772-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128518104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker