Provider Demographics
NPI:1275267635
Name:BOHN, LYDIA JANE (MS)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:JANE
Last Name:BOHN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4347
Mailing Address - Country:US
Mailing Address - Phone:802-864-7423
Mailing Address - Fax:802-660-0576
Practice Address - Street 1:31 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4347
Practice Address - Country:US
Practice Address - Phone:802-864-7423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)