Provider Demographics
NPI:1215273933
Name:SWINKIN, LIDIA ANNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:ANNA
Last Name:SWINKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PURICK ST
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1505
Mailing Address - Country:US
Mailing Address - Phone:631-472-4246
Mailing Address - Fax:
Practice Address - Street 1:55 PURICK ST
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1505
Practice Address - Country:US
Practice Address - Phone:631-472-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
NY024294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool