Provider Demographics
NPI:1619001195
Name:LYDEN, ERIC CHRISTIAN (MA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CHRISTIAN
Last Name:LYDEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4231
Mailing Address - Country:US
Mailing Address - Phone:818-426-6967
Mailing Address - Fax:
Practice Address - Street 1:4881 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-426-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist