Provider Demographics
NPI:1770681553
Name:CARDONE, LIDIA (PHD CLINICAL PSYCH)
Entity type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:
Last Name:CARDONE
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAIN STREET
Mailing Address - Street 2:SUITE 100-43
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2762
Mailing Address - Country:US
Mailing Address - Phone:843-816-9533
Mailing Address - Fax:
Practice Address - Street 1:400 MAIN STREET
Practice Address - Street 2:SUITE 100-43
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2762
Practice Address - Country:US
Practice Address - Phone:843-816-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY00004892103TC0700X
SC1848103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59422CMedicare ID - Type UnspecifiedPSYCHOLOGIST