Healthcare Provider Details

I. General information

NPI: 1689809998
Provider Name (Legal Business Name): LYDIA ALMA TREMBLAY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OPTICAL DR FL 3
SOUTHBRIDGE MA
01550-2559
US

IV. Provider business mailing address

5 OPTICAL DR FL 3
SOUTHBRIDGE MA
01550-2559
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-9101
  • Fax: 508-764-7389
Mailing address:
  • Phone: 508-765-9101
  • Fax: 508-764-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: