Provider Demographics
NPI:1841238268
Name:CYNTHIA L LYDIARD
Entity Type:Organization
Organization Name:CYNTHIA L LYDIARD
Other - Org Name:HELEN'S BRA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LYDIARD
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED FITTER
Authorized Official - Phone:413-786-3383
Mailing Address - Street 1:62 SUFFIELD ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1752
Mailing Address - Country:US
Mailing Address - Phone:413-786-3383
Mailing Address - Fax:
Practice Address - Street 1:62 SUFFIELD ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1752
Practice Address - Country:US
Practice Address - Phone:413-786-3383
Practice Address - Fax:413-786-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1540319Medicaid
TN4034826OtherBLUE CROSS BLUE SHIELD
MA734923OtherCONNECTICARE
MA31283950001OtherCIGNA
MA607765OtherTUFTS
000393354OtherBLUE CROSS BLUE SHIELD
CT003110856Medicaid
MA=========OtherPIONEER
MA1540319Medicaid
MA1540319Medicaid