Provider Demographics
NPI:1215926456
Name:LYDEN, MARTIN JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOSEPH
Last Name:LYDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-1420
Mailing Address - Country:US
Mailing Address - Phone:518-271-6949
Mailing Address - Fax:518-449-7965
Practice Address - Street 1:267 HOOSICK ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2467
Practice Address - Country:US
Practice Address - Phone:518-271-6949
Practice Address - Fax:518-449-7965
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006029103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00568790Medicaid
NY6111201OtherUNITED BEHAVIORAL HEALTH
NY141721313OtherVALUEOPTIONS
NY41171OtherMVP
NY000490239002OtherBLUE SHIELD OF NENY
NY58184OtherCIGNA
NY141721313OtherVALUEOPTIONS