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General NPI Number Information
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NPI Number | 1376360768
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Entity Type | Individual
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Provider Name | DANIEL LYDON JR. PHD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1 PARK AVE FL 8
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City | NEW YORK
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State | NY
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Zip | 10016-5802
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Country | US
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Telephone | 646-754-5465
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Fax |
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Provider Business Mailing Address
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Address Line | 303 RICHARD AVE APT AB4
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City | HICKSVILLE
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State | NY
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Zip | 11801-1225
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Country | US
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Telephone | 631-346-2806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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