Fonda Althea Lyles, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

4400 Bruce Farm Dr
Suffolk, VA 23435-1255

Phone

(757) 537-2919

NPI assigned

Jun 6, 2017

Last updated

May 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Engaged N Purpose

  • Community/Behavioral Health Agency
  • Suffolk, VA
  • NPI 1447944426
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1194254821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 BRUCE FARM DR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234351255",
            "telephone_number": "757-537-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 BRUCE FARM DR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234351255",
            "telephone_number": "757-537-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYLES",
        "first_name": "FONDA",
        "middle_name": "ALTHEA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-06",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904008885",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Christian Lutchko, MSOT, OTR
• Luxottica of America Inc (Lenscrafters #767)
• Maria Lyall, PT
• Lyfetyme Home Care LLC (Lyfetyme Home Care)
• Lacey Dooley Lyle, F.N.P.
• Edward Michael Lynch, DO
• Kathryn Lynch
• Lynne C. Faxio, DDS, P.C.
• Angela Bowers Mabalot, PT, DPT
• Constancia Fatima Macatangay Geronilla, M.D.

• Clinical Social Worker in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.