Individual
LYDIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
227 BABCOCK ST, BROOKLINE, MA 02446-6773
(585) 245-3784
Mailing address
3 SEMINOLE AVE, GENESEO, NY 14454-9509
(585) 245-3784
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2022
Last updated
12/12/2022
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