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General NPI Number Information
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NPI Number | 1346597614
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Entity Type | Organization
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Legal Business Name | KEITH LYONS COUNSELING LCSW PLLC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 555 BROADHOLLOW RD SUITE 216
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City | MELVILLE
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State | NY
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Zip | 11747-5078
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Country | US
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Telephone | 516-730-6124
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Fax | 631-759-2708
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Provider Business Mailing Address
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Address Line | PO BOX 90
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City | HUNTINGTON
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State | NY
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Zip | 11743-0090
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Country | US
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Telephone | 516-730-6124
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. KEITH LYONS
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Credential | LCSWR
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Telephone | 516-730-6124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R0775006-1
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License Number State | NY
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