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NPI Code Detail

MEDICARE: SYMONE LYLES

MEDICARE: SYMONE LYLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker21770MD

General Provider Information

NPI Number : 1366909293
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYMONE LYLES
Provider Business Mailing Address
First Line : 13400 EDGEMEADE RD
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-8088
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13400 EDGEMEADE RD
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-8088
Country : US
Telephone Number : 240-681-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2019
Last Update Date : 02/27/2019

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Directions to “ SYMONE LYLES ” Practice Location

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