Provider Demographics
NPI:1629372404
Name:REST, LYDIA DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:DIANE
Last Name:REST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:DIANE
Other - Last Name:KERNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:14373 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-8628
Mailing Address - Country:US
Mailing Address - Phone:518-669-2097
Mailing Address - Fax:
Practice Address - Street 1:62 ORCHARD RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-2700
Practice Address - Country:US
Practice Address - Phone:518-669-2097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077410-011041C0700X
NY077410-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical