Provider Demographics
NPI:1982102562
Name:WIDRIG, LINDSAY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:WIDRIG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0838
Mailing Address - Country:US
Mailing Address - Phone:315-308-1248
Mailing Address - Fax:
Practice Address - Street 1:43 OSWEGO ST STE 100
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2425
Practice Address - Country:US
Practice Address - Phone:315-308-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist