MEDICARE: ZOE LYON-GOLDMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1104342062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE LYON-GOLDMAN LCSW

Provider Business Mailing Address
First Line	:	3959 S NOVA RD STE 12
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4900
Country	:	US
Telephone Number	:	386-227-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	3959 S NOVA RD STE 12
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4900
Country	:	US
Telephone Number	:	386-227-6590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	01/20/2026

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