Provider Demographics
NPI:1447502448
Name:LYDEN, JOHANNA CARPENTER (PHD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:CARPENTER
Last Name:LYDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:710 YORKLYN RD STE 100
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8748
Practice Address - Country:US
Practice Address - Phone:302-239-5255
Practice Address - Fax:302-239-5531
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB10000934103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent