Basic Information
| Provider Information | |||||||||
| NPI: | 1649768391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | CORI | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 72 PRIEST ST | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017491743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788751909 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 OLD CANAL DR | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018512730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784536800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2018 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.