Healthcare Provider Details

I. General information

NPI: 1215013438
Provider Name (Legal Business Name): BARBARA ANN LYRENE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 ASSUNTA COURT SUITE A
FAIRHOPE AL
36532
US

IV. Provider business mailing address

7525 ASSUNTA COURT SUITE A
FAIRHOPE AL
36532
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-6292
  • Fax: 251-928-2250
Mailing address:
  • Phone: 251-928-6292
  • Fax: 251-928-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPIP2390994C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: