Provider Demographics
NPI:1215343074
Name:LYDON, KAITLIN GRACE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:GRACE
Last Name:LYDON
Suffix:
Gender:
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1649
Mailing Address - Country:US
Mailing Address - Phone:516-984-6140
Mailing Address - Fax:
Practice Address - Street 1:1610 PALM AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1649
Practice Address - Country:US
Practice Address - Phone:516-984-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000428103K00000X
FL1-14-10396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst