Provider Demographics
NPI:1417284704
Name:VIDLER, LINDSAY SOMMERS (MSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:SOMMERS
Last Name:VIDLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 CODDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6022
Mailing Address - Country:US
Mailing Address - Phone:607-592-3088
Mailing Address - Fax:
Practice Address - Street 1:426 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-1638
Practice Address - Country:US
Practice Address - Phone:585-719-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP73431104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker