Lyde, Gordon Wesley
Lyde, Gordon Wesley is an sole proprietor health care provider with primary practice located at 76 Jackson St , Torrington CT 06790-6202. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Lyde, Gordon Wesley can be contacted via phone (860) 491-8511.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | Connecticut |
Profile Details
| NPI number | 1346873767 |
|---|---|
| LBN Legal business name | Lyde, Gordon Wesley |
| Credentials | CAC, CADC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 13th, 2020 |
| Last updated | Feb 13th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346873767 | NPPES |
| Connecticut | MEDICAID | 096272748 |
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