MEDICARE: LIDIA CARDONE, PH.D.P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1114745080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIDIA CARDONE, PH.D.P.A.

Provider Business Mailing Address
First Line	:	400 MAIN ST STE 100A3
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-4624
Country	:	US
Telephone Number	:	843-716-9533
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 MAIN ST STE 100A3
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-4624
Country	:	US
Telephone Number	:	843-716-9533
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LIDIA CARDONE
Credential	:	PH.D.
Telephone Number	:	843-816-9533

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	09/30/2024

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