Provider Demographics
NPI:1013651785
Name:BRONSON, LYDIA MARIE (MED, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:BRONSON
Suffix:
Gender:F
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:MARIE
Other - Last Name:FERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4321 DOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2510
Mailing Address - Country:US
Mailing Address - Phone:850-381-1333
Mailing Address - Fax:
Practice Address - Street 1:4321 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2510
Practice Address - Country:US
Practice Address - Phone:850-381-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-23-14587106E00000X
106S00000X
OH1-23-69604103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician