Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-19-38359 | |
N | 106E00000X | Assistant Behavior Analyst | 0-17-8532 |
NPI | 1023513801 |
---|---|
Provider Name | Amber M Lydon |
First Address | Stuart, FL 34997-7462 |
Second Address | Wilbraham, MA 01095-1743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 28/06/2021 |