Individual
DR. LYDIA KENIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LICSW
Contact information
Practice address
45 METACOMET RD, WABAN, MA 02468-1418
(617) 969-7393
Mailing address
45 METACOMET RD, WABAN, MA 02468-1418
(617) 969-7393
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4186
MA
1041C0700X
Clinical Social Worker
103930
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W50166
MEDICARE PARTICIPATING SUPPLIER IDENTIFICATION CODE
MA
01
—
WO5557
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/06/2009
Last updated
01/06/2009
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