Provider Demographics
NPI:1336492404
Name:LYMES' YOUTH SERVICE BUREAU
Entity Type:Organization
Organization Name:LYMES' YOUTH SERVICE BUREAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:VARISCO
Authorized Official - Last Name:SEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-434-7208
Mailing Address - Street 1:59 LYME ST
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-2359
Mailing Address - Country:US
Mailing Address - Phone:860-434-7208
Mailing Address - Fax:860-434-1580
Practice Address - Street 1:59 LYME ST
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-2359
Practice Address - Country:US
Practice Address - Phone:860-434-7208
Practice Address - Fax:860-434-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty