Provider Demographics
NPI:1356615199
Name:MAZARIEGOS-DE LEON, LYDIA CLARITA (MA, LMHC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:CLARITA
Last Name:MAZARIEGOS-DE LEON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 QUEEN ANNE AVE N
Mailing Address - Street 2:SUITE #407
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2876
Mailing Address - Country:US
Mailing Address - Phone:206-883-7687
Mailing Address - Fax:
Practice Address - Street 1:1817 QUEEN ANNE AVE N
Practice Address - Street 2:SUITE #407
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2876
Practice Address - Country:US
Practice Address - Phone:206-883-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60200540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health