Healthcare Provider Details

I. General information

NPI: 1417008137
Provider Name (Legal Business Name): MARK DEWITT LANYON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 W 2ND ST
WILMINGTON DE
19805-1807
US

IV. Provider business mailing address

2814 W 2ND ST
WILMINGTON DE
19805-1807
US

V. Phone/Fax

Practice location:
  • Phone: 302-472-0381
  • Fax: 302-472-0392
Mailing address:
  • Phone: 302-472-0381
  • Fax: 302-472-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: