Healthcare Provider Details

I. General information

NPI: 1134912025
Provider Name (Legal Business Name): HALEY JORDAN LYONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 IYANNOUGH RD
HYANNIS MA
02601-1871
US

IV. Provider business mailing address

16 ORIOLE LN
SANDWICH MA
02563-2329
US

V. Phone/Fax

Practice location:
  • Phone: 508-948-3400
  • Fax:
Mailing address:
  • Phone: 267-614-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2120688
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: