Provider Demographics
NPI:1326278433
Name:MAROHN, LYDIA DRYER (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:DRYER
Last Name:MAROHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 S MARION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5261
Mailing Address - Country:US
Mailing Address - Phone:386-961-9616
Mailing Address - Fax:386-754-1325
Practice Address - Street 1:356 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5261
Practice Address - Country:US
Practice Address - Phone:386-961-9616
Practice Address - Fax:386-754-1325
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLMH3393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6325OtherBLUE CROSS BLUE SHIELD OF FLORIDA