Provider Demographics
NPI:1346527967
Name:WIDDER, DEE ANN LLOYD (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEE ANN
Middle Name:LLOYD
Last Name:WIDDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7314
Mailing Address - Country:US
Mailing Address - Phone:302-674-2380
Mailing Address - Fax:302-674-1299
Practice Address - Street 1:156 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7314
Practice Address - Country:US
Practice Address - Phone:302-674-2380
Practice Address - Fax:302-674-1299
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00011161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1346527967Medicaid