MEDICARE: MS. PATRICIA LYONS LISW-S

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	1041C0700X	Clinical Social Worker	I.0009129	OH

General Provider Information

NPI Number	:	1386919876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA LYONS LISW-S

Provider Business Mailing Address
First Line	:	1234 DUTTON PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1724
Country	:	US
Telephone Number	:	614-546-7815
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 DUTTON PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1724
Country	:	US
Telephone Number	:	614-546-7815
Fax Number	:

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

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/15/2012

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