Provider Demographics
NPI:1235782210
Name:LYDEN, JADE M (BA, CT)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:M
Last Name:LYDEN
Suffix:
Gender:F
Credentials:BA, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-2310
Mailing Address - Fax:330-759-0030
Practice Address - Street 1:520 YOUNGSTOWN POLAND RD
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1103
Practice Address - Country:US
Practice Address - Phone:330-318-3078
Practice Address - Fax:330-855-1072
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901942-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health