Provider Demographics
NPI:1902504251
Name:BARKWELL-LYDON, MILDRED CARLA
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:CARLA
Last Name:BARKWELL-LYDON
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 1:322 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:ANTRIM
Mailing Address - State:NH
Mailing Address - Zip Code:03440-3509
Mailing Address - Country:US
Mailing Address - Phone:617-966-3094
Mailing Address - Fax:
Practice Address - Street 1:322 CLINTON RD
Practice Address - Street 2:
Practice Address - City:ANTRIM
Practice Address - State:NH
Practice Address - Zip Code:03440-3509
Practice Address - Country:US
Practice Address - Phone:617-966-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist