Provider Demographics
NPI:1558714089
Name:GNACADJA, LYDIE HELENE (LICSW)
Entity type:Individual
Prefix:
First Name:LYDIE
Middle Name:HELENE
Last Name:GNACADJA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LYDIE
Other - Middle Name:HELENE ALVES
Other - Last Name:GNACADJA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:555 N MAIN ST # 1088
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5722
Mailing Address - Country:US
Mailing Address - Phone:401-753-2425
Mailing Address - Fax:
Practice Address - Street 1:555 N MAIN ST # 1088
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5722
Practice Address - Country:US
Practice Address - Phone:401-753-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW123163101YM0800X, 1041C0700X
VA09040170821041C0700X, 101YM0800X
RIISW03087101YM0800X, 1041C0700X
FLSW24730101YM0800X, 1041C0700X
CT14544101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1002170OtherBEACON HEALTH STRATEGIES
MA10258OtherMEDICARE