Provider Demographics
NPI:1891989364
Name:LYMAN, DAVID RUSSELL (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
Last Name:LYMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:D
Other - Middle Name:RUSSELL
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:65 GAY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492
Mailing Address - Country:US
Mailing Address - Phone:781-449-2898
Mailing Address - Fax:781-449-2898
Practice Address - Street 1:5 SACRAMENTO ST
Practice Address - Street 2:GUIDANCE CENTER INC
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-354-2275
Practice Address - Fax:617-547-4355
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4240103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist