Provider Demographics
NPI:1699269571
Name:LYONS, CAMERON JOHN (MA)
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:JOHN
Last Name:LYONS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1556
Mailing Address - Country:US
Mailing Address - Phone:781-774-0702
Mailing Address - Fax:
Practice Address - Street 1:69 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1556
Practice Address - Country:US
Practice Address - Phone:781-774-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2024-05-25
Deactivation Date:2021-08-31
Deactivation Code:
Reactivation Date:2022-06-07
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician