Individual
MARY LYDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 KAMOKILA BLVD STE 210, KAPOLEI, HI 96707-2096
(808) 591-6060
Mailing address
92-1230 HOOKEHA ST, KAPOLEI, HI 96707-1530
(808) 439-9691
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-306806
HI
Other
Enumeration date
11/24/2023
Last updated
11/24/2023
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