Provider Demographics
NPI:1518358506
Name:TONI LIDDY LLC
Entity Type:Organization
Organization Name:TONI LIDDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LIDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC NCC
Authorized Official - Phone:414-429-6522
Mailing Address - Street 1:2369 S 57TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2215
Mailing Address - Country:US
Mailing Address - Phone:414-429-6522
Mailing Address - Fax:414-502-0192
Practice Address - Street 1:800 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2634
Practice Address - Country:US
Practice Address - Phone:414-429-6522
Practice Address - Fax:414-502-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI244-125101Y00000X, 101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty