Provider Demographics
NPI:1033817507
Name:KEHOE, LYDIA (LMHC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:KEHOE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 CURRY RD APT 232
Mailing Address - Street 2:
Mailing Address - City:ROTTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12306-4257
Mailing Address - Country:US
Mailing Address - Phone:518-225-9214
Mailing Address - Fax:
Practice Address - Street 1:8 SOUTHWOODS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2508
Practice Address - Country:US
Practice Address - Phone:518-225-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015339101YM0800X
101YM0800X
NYP104804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health