Provider Demographics
NPI:1255500419
Name:LYDIA'S PLACE, INC.
Entity Type:Organization
Organization Name:LYDIA'S PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:412-391-1013
Mailing Address - Street 1:710 5TH AVE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-3003
Mailing Address - Country:US
Mailing Address - Phone:412-391-1013
Mailing Address - Fax:
Practice Address - Street 1:710 5TH AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-3003
Practice Address - Country:US
Practice Address - Phone:412-391-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management