Provider Demographics
NPI:1427894310
Name:K LIDZ NP IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:K LIDZ NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-619-9846
Mailing Address - Street 1:1983 NEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8438
Mailing Address - Country:US
Mailing Address - Phone:803-619-9846
Mailing Address - Fax:803-913-5275
Practice Address - Street 1:6520 SW THISTLE TER
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3857
Practice Address - Country:US
Practice Address - Phone:803-619-9846
Practice Address - Fax:803-913-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty