Provider Demographics
NPI:1255119020
Name:CARON, LYDIA M
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:M
Last Name:CARON
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 1:61 ARI DR APT 309
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-5005
Mailing Address - Country:US
Mailing Address - Phone:207-991-0930
Mailing Address - Fax:
Practice Address - Street 1:61 ARI DR APT 309
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-5005
Practice Address - Country:US
Practice Address - Phone:207-991-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program