Provider Demographics
NPI:1811049919
Name:TRYON, MARCIA LYNN (M)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:TRYON
Suffix:
Gender:F
Credentials:M
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:LYNN
Other - Last Name:TAVARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-0908
Mailing Address - Country:US
Mailing Address - Phone:401-862-5248
Mailing Address - Fax:401-324-5274
Practice Address - Street 1:421 CURRANT RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-4712
Practice Address - Country:US
Practice Address - Phone:401-862-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA6722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health