Provider Demographics
NPI:1922443837
Name:LYDA, TABITHA (MED)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:LYDA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:4055 DALEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 W BEAVER ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1582
Practice Address - Country:US
Practice Address - Phone:724-452-4453
Practice Address - Fax:724-452-6576
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional