Lydia Gayle Grande, RBT
Individual provider Active NPI Behavior Technician · Perry Hall, MD
NPI 1972296887 · NPPES record last updated May 29, 2023
Key facts
- NPI
- 1972296887
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- 23-2759926 (VA)
- Practice address
- 9096 Rexis Ave
Perry Hall, MD 21128-9021 - Phone
- (443) 453-2031
- Fax
- (443) 216-7397
- NPI assigned
- May 29, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-2759926 | VA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advancing Abilities, LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 23-2759926 | VA | Yes |
Addresses
Primary practice location
9096 Rexis Ave
Perry Hall, MD 21128-9021
Mailing address
9096 Rexis Ave
Perry Hall, MD 21128-9021
Phone (443) 453-2031
Other providers in Perry Hall, MD
- Franklin Square Hospital Center Inc
- Franklin Square Hospital Center Inc
- Isis Fuller
- Chanel Gilford
- Goodnews Health Service Inc
- Gratitude Medical Services LLC
- Rachel Niloufar Habibi
- Rabbia Hasan
- Elizabeth Anna-Victoria Heck
- Noah Heitner
All providers in Perry Hall, MD · Behavior Technician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.