Doctor Name: | DR. VICKI LYNN LYALL |
NPI Number: | 1821203712 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 3052 |
Business Practice Address: | 7 Gorwin Dr Hanson, MA - 023411309 |
Business Phone Number: | 7812934564 |
Business Fax Number: | 7812934564 |
Mailing Address: | 7 Gorwin Dr, Po Box 367 HANSON |
State: | MA |
Postal Code: | 023411309 |
Phone Number: | 7812934564 |
Fax Number: | 7812934564 |
NPI Enumeration Date: | 05/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3052 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |