Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3569 | CT |
Y | 103T00000X | Psychologist | 3569 | CT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3569 | CT |
N | 103TC1900X | Counseling Psychologist | 3569 | CT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3569 | CT |
N | 103TH0100X | Health Service | 3569 | CT |
NPI | 1023771052 |
---|---|
Provider Name | Janet Lydecker |
First Address | New Haven, CT 06511-3915 |
Second Address | New Haven, CT 06511-3915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2021 |
Last Update Date | 17/10/2021 |