Provider Demographics
NPI:1275386278
Name:MARIZETTE, LYDIA JANE
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:JANE
Last Name:MARIZETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 W FAIRMONT AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0123
Mailing Address - Country:US
Mailing Address - Phone:559-403-3219
Mailing Address - Fax:
Practice Address - Street 1:1388 E BULLDOG LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7209
Practice Address - Country:US
Practice Address - Phone:559-403-3219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)