Provider Demographics
NPI:1255860094
Name:KARA LYDON, INC.
Entity Type:Organization
Organization Name:KARA LYDON, INC.
Other - Org Name:KARA LYDON, RD, LDN, RYT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYDON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, RYT
Authorized Official - Phone:716-200-3236
Mailing Address - Street 1:140 ARBORWAY APT 5
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3522
Mailing Address - Country:US
Mailing Address - Phone:716-200-3236
Mailing Address - Fax:
Practice Address - Street 1:30 NEWBURY ST STE 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3241
Practice Address - Country:US
Practice Address - Phone:716-200-3236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3090133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty