Provider Demographics
NPI:1720411028
Name:BYRD, LYDIA (BSW)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N 35TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7602
Mailing Address - Country:US
Mailing Address - Phone:804-873-1583
Mailing Address - Fax:804-222-8492
Practice Address - Street 1:914 N 35TH ST FL 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7602
Practice Address - Country:US
Practice Address - Phone:804-873-1583
Practice Address - Fax:804-222-8492
Is Sole Proprietor?:No
Enumeration Date:2013-08-10
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0156636778171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0156636778Medicaid
VA0158053741Medicaid