Provider Demographics
NPI:1124382452
Name:MOORE, LYDIA (LCSW-R)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:COYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:337 CLEVELAND DR STE 6
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1952
Mailing Address - Country:US
Mailing Address - Phone:716-220-7155
Mailing Address - Fax:
Practice Address - Street 1:337 CLEVELAND DR STE 6
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14215-1952
Practice Address - Country:US
Practice Address - Phone:716-220-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0830661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical