Healthcare Provider Details

I. General information

NPI: 1326701202
Provider Name (Legal Business Name): LYRIC KLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 BROADWAY
WOODMERE NY
11598-1227
US

IV. Provider business mailing address

1007 BROADWAY
WOODMERE NY
11598-1227
US

V. Phone/Fax

Practice location:
  • Phone: 948-222-4968
  • Fax: 804-710-2054
Mailing address:
  • Phone: 948-222-4968
  • Fax: 804-710-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000681
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: