Provider Demographics
NPI:1588336002
Name:OUGH, LYDIA MARIE
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:OUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 BARKER RD
Mailing Address - Street 2:
Mailing Address - City:DOLGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13329
Mailing Address - Country:US
Mailing Address - Phone:518-774-0205
Mailing Address - Fax:
Practice Address - Street 1:8387 SENECA TURNPIKE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-732-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician