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NPI Code Detail

MEDICARE: ROBERT D LYDON COUNSELOR

MEDICARE: ROBERT D LYDON COUNSELOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor00002930WA

General Provider Information

NPI Number : 1427321462
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT D LYDON COUNSELOR
Provider Business Mailing Address
First Line : 1116 SUMMIT AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98101-2831
Country : US
Telephone Number : 206-323-0930
Fax Number : 206-323-0933
Provider Business Practice Location Address
First Line : 1116 SUMMIT AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98101-2831
Country : US
Telephone Number : 206-323-0930
Fax Number : 206-323-0933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2012
Last Update Date : 02/22/2012

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