Provider Demographics
NPI:1578052908
Name:LIVELY, LYDIA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:LIVELY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:MA
Mailing Address - Zip Code:01346-0013
Mailing Address - Country:US
Mailing Address - Phone:413-774-0918
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3275
Practice Address - Country:US
Practice Address - Phone:413-774-6252
Practice Address - Fax:413-773-0477
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2231801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical