Provider Demographics
NPI:1760586226
Name:LIDSKER, JOAN WYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:WYNNE
Last Name:LIDSKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ROCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1211
Mailing Address - Country:US
Mailing Address - Phone:412-572-7093
Mailing Address - Fax:
Practice Address - Street 1:615 E MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3497
Practice Address - Country:US
Practice Address - Phone:724-942-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008929L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist