Provider Demographics
NPI:1134508468
Name:KIDDER, MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KIDDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIDI
Other - Middle Name:HUDSON
Other - Last Name:KIDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:750 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4635
Mailing Address - Country:US
Mailing Address - Phone:214-232-3439
Mailing Address - Fax:817-275-8601
Practice Address - Street 1:4223 LOMO ALTO CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1508
Practice Address - Country:US
Practice Address - Phone:214-232-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical