Provider Demographics
NPI:1902286594
Name:HYDE, CAROL
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:HYDE
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 1:1250 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1577
Mailing Address - Country:US
Mailing Address - Phone:440-204-1700
Mailing Address - Fax:440-204-1730
Practice Address - Street 1:1250 SANFORD ST
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1577
Practice Address - Country:US
Practice Address - Phone:440-204-1700
Practice Address - Fax:440-204-1730
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCL1002750103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool