Provider Demographics
NPI:1518591825
Name:LYDON, NICHOLA (LCSW, CPRS)
Entity type:Individual
Prefix:
First Name:NICHOLA
Middle Name:
Last Name:LYDON
Suffix:
Gender:F
Credentials:LCSW, CPRS
Other - Prefix:MRS
Other - First Name:NICHOLA
Other - Middle Name:
Other - Last Name:LYDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LCADC
Mailing Address - Street 1:11 HALSTED ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2086
Mailing Address - Country:US
Mailing Address - Phone:973-362-6010
Mailing Address - Fax:888-466-2358
Practice Address - Street 1:11 HALSTED ST APT B
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2086
Practice Address - Country:US
Practice Address - Phone:973-862-7275
Practice Address - Fax:888-466-2358
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC0082800101YA0400X
PACW0251611041C0700X
CT144641041C0700X
NJ44SC062714001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)