Provider Demographics
NPI:1871927095
Name:LYLE, ANTOINETTE (MA)
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 WHEATLAND ST
Mailing Address - Street 2:STE.1A
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5361
Mailing Address - Country:US
Mailing Address - Phone:610-415-9301
Mailing Address - Fax:610-415-1656
Practice Address - Street 1:723 WHEATLAND ST
Practice Address - Street 2:STE.1A
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-5361
Practice Address - Country:US
Practice Address - Phone:610-415-9301
Practice Address - Fax:610-415-1656
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007200101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional