Healthcare Provider Details

I. General information

NPI: 1124497581
Provider Name (Legal Business Name): LIDIA CAZA-BURDICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

PO BOX 2087
MERCED CA
95344-0087
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-6880
  • Fax: 209-723-6220
Mailing address:
  • Phone: 209-381-6850
  • Fax: 209-723-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS27092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: