Healthcare Provider Details

I. General information

NPI: 1447813019
Provider Name (Legal Business Name): LYDIA ABATKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S MEADOW DR
BURLINGTON VT
05401-5375
US

IV. Provider business mailing address

10 S MEADOW DR
BURLINGTON VT
05401-5375
US

V. Phone/Fax

Practice location:
  • Phone: 678-469-9255
  • Fax:
Mailing address:
  • Phone: 678-469-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097.0137036
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: