Provider Demographics
NPI:1255214615
Name:NEGRON, LYDIA (MT-BC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 E LE MARCHE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3147
Mailing Address - Country:US
Mailing Address - Phone:602-842-1924
Mailing Address - Fax:
Practice Address - Street 1:1053 E LE MARCHE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3147
Practice Address - Country:US
Practice Address - Phone:602-842-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15021225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist