Organization
LYDIA P PERRY LPC LADC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE ROACH (PRACTICE ADMINISTRATOR)
(860) 368-7092
Entity
Organization
Contact information
Practice address
1 FORT HILL RD STE 6, GROTON, CT 06340-4799
(860) 705-9630
Mailing address
12 WATER ST APT 304, MYSTIC, CT 06355-2534
(860) 705-9630
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
11/12/2021
Last updated
01/14/2023
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