Provider Demographics
NPI:1275671513
Name:LYDIA HOME ASSOCIATION
Entity type:Organization
Organization Name:LYDIA HOME ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:908-359-3267
Mailing Address - Street 1:170 TOWNSHIP LINE ROAD
Mailing Address - Street 2:BLDG A 2ND FLOOR
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844
Mailing Address - Country:US
Mailing Address - Phone:908-359-3267
Mailing Address - Fax:908-359-0274
Practice Address - Street 1:170 TOWNSHIP LINE ROAD
Practice Address - Street 2:BLDG A 2ND FLOOR
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844
Practice Address - Country:US
Practice Address - Phone:908-359-3267
Practice Address - Fax:908-359-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty