Provider Demographics
NPI:1770869349
Name:VINCI, LIDIA (MA)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:VINCI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 TUSCANY AVE
Mailing Address - Street 2:#219
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8158
Mailing Address - Country:US
Mailing Address - Phone:310-955-7401
Mailing Address - Fax:
Practice Address - Street 1:8512 TUSCANY AVE
Practice Address - Street 2:#219
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8158
Practice Address - Country:US
Practice Address - Phone:310-955-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070176814101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA070176814OtherSCHOOL PSYCHOLOGIST