Provider Demographics
NPI:1962508275
Name:LYDECKER, JUDY A (LCSW LADC)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:A
Last Name:LYDECKER
Suffix:
Gender:F
Credentials:LCSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1727
Mailing Address - Country:US
Mailing Address - Phone:860-485-2559
Mailing Address - Fax:860-379-7421
Practice Address - Street 1:92 HIGH ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1527
Practice Address - Country:US
Practice Address - Phone:860-485-2559
Practice Address - Fax:860-379-7421
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLCSW0058571041C0700X
CTLADC0006191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT80003554Medicare ID - Type Unspecified