Provider Demographics
NPI:1518301829
Name:LYDIARD, LAURA (LMHC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LYDIARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLUMBIA ROAD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2110
Mailing Address - Country:US
Mailing Address - Phone:781-826-2270
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1842
Practice Address - Country:US
Practice Address - Phone:781-826-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8299101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor