Provider Demographics
NPI:1598328007
Name:LYONS, SCOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:380 BUTLER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3103
Mailing Address - Country:US
Mailing Address - Phone:917-572-3548
Mailing Address - Fax:
Practice Address - Street 1:380 BUTLER ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3103
Practice Address - Country:US
Practice Address - Phone:917-572-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO8580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist