Healthcare Provider Details

I. General information

NPI: 1982980942
Provider Name (Legal Business Name): MICHELLE SARA LYONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE SARA LEVINSON

II. Dates (important events)

Enumeration Date: 10/22/2011
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MAIN STREET SUITE 300
BROCKTON MA
02301
US

IV. Provider business mailing address

231 MAIN STREET SUITE 300
BROCKTON MA
02301
US

V. Phone/Fax

Practice location:
  • Phone: 508-586-2660
  • Fax: 508-427-1505
Mailing address:
  • Phone: 508-586-2660
  • Fax: 508-427-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: