Healthcare Provider Details

I. General information

NPI: 1639655772
Provider Name (Legal Business Name): ERICA B LANNON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD
LYONS NY
14489-9133
US

IV. Provider business mailing address

1519 NYE RD
LYONS NY
14489-9133
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5722
  • Fax: 315-946-7005
Mailing address:
  • Phone: 315-946-5722
  • Fax: 315-946-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: