Healthcare Provider Details

I. General information

NPI: 1770652885
Provider Name (Legal Business Name): CAMILLA L LYONS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E PUTNAM AVE STE 116
GREENWICH CT
06830-5428
US

IV. Provider business mailing address

45 E PUTNAM AVE STE 116
GREENWICH CT
06830-5428
US

V. Phone/Fax

Practice location:
  • Phone: 203-202-2551
  • Fax: 888-263-6750
Mailing address:
  • Phone: 203-202-2551
  • Fax: 888-263-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number55627
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number243521
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number243521
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number55627
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number243521
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number55627
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: