MEDICARE: KIRSTEN MARGARET LYONS LSW, MED

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	SW138815	PA

General Provider Information

NPI Number	:	1902683683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN MARGARET LYONS LSW, MED

Provider Business Mailing Address
First Line	:	4928 PINE ST UNIT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1613
Country	:	US
Telephone Number	:	717-817-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	4928 PINE ST UNIT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1613
Country	:	US
Telephone Number	:	717-817-1201
Fax Number	:

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

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	09/14/2023

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