Provider Demographics
NPI:1053098616
Name:REYES, LYDIA MERCEDES (CARC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MERCEDES
Last Name:REYES
Suffix:
Gender:F
Credentials:CARC
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CARC-5268
Mailing Address - Street 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
Mailing Address - Country:US
Mailing Address - Phone:857-262-2975
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:857-262-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)