Healthcare Provider Details

I. General information

NPI: 1730430299
Provider Name (Legal Business Name): ERIN E LYRISTAKIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 BATHEY LN
NAPLES FL
34116-7536
US

IV. Provider business mailing address

6075 BATHEY LN
NAPLES FL
34116-7536
US

V. Phone/Fax

Practice location:
  • Phone: 239-455-8500
  • Fax: 239-455-6561
Mailing address:
  • Phone: 239-455-8500
  • Fax: 239-455-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: