Provider Demographics
NPI:1912330986
Name:TREADWAY, LYDIA EMILY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:EMILY
Last Name:TREADWAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TRIPHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-8065
Mailing Address - Country:US
Mailing Address - Phone:518-812-0757
Mailing Address - Fax:
Practice Address - Street 1:47 TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-8065
Practice Address - Country:US
Practice Address - Phone:518-812-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014679103G00000X, 103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 251S00000X
014679103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No251S00000XAgenciesCommunity/Behavioral Health