Healthcare Provider Details

I. General information

NPI: 1598880536
Provider Name (Legal Business Name): MATTHEW JAMES LYMAN PMHNP, ANP, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 G ST NW STE 200EAST
WASHINGTON DC
20001-4545
US

IV. Provider business mailing address

130 SUTTER ST FL 2
SAN FRANCISCO CA
94104-4009
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-0005
  • Fax: 202-660-0025
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-520-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111458
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1043976
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1043976
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: