Provider Demographics
NPI:1487086013
Name:ADJETEY, LYDIA Y
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:Y
Last Name:ADJETEY
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 1:230 HIGHLAND AVE
Mailing Address - Street 2:SON, RM. 409
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1408
Mailing Address - Country:US
Mailing Address - Phone:617-591-6787
Mailing Address - Fax:
Practice Address - Street 1:391 BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3470
Practice Address - Country:US
Practice Address - Phone:617-389-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker