MEDICARE: DR. MICHELE M LYONS PSYD

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	103TC0700X	Clinical Psychologist	7907	MA

General Provider Information

NPI Number	:	1356365811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE M LYONS PSYD

Provider Business Mailing Address
First Line	:	11 MIDSTATE DR STE 3
Second Line	:
City	:	AUBURN
State	:	MA
Zip	:	01501-1882
Country	:	US
Telephone Number	:	781-474-5256
Fax Number	:	781-551-3396

Provider Business Practice Location Address
First Line	:	11 MIDSTATE DR STE 3
Second Line	:
City	:	AUBURN
State	:	MA
Zip	:	01501-1882
Country	:	US
Telephone Number	:	781-474-5256
Fax Number	:	781-551-3396

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/21/2022

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