Healthcare Provider Details

I. General information

NPI: 1871446880
Provider Name (Legal Business Name): KELLY DEHART LYDIKSEN LMFT-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MAIN ST
OLD SAYBROOK CT
06475-2350
US

IV. Provider business mailing address

6 BEVIN AVE
EAST HAMPTON CT
06424-1201
US

V. Phone/Fax

Practice location:
  • Phone: 860-395-3190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3807
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: