Healthcare Provider Details

I. General information

NPI: 1386508935
Provider Name (Legal Business Name): LYDIA FANDRY WALTERICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 BROADWAY AVE
PITTSBURGH PA
15216-2129
US

IV. Provider business mailing address

2837 BROADWAY AVE
PITTSBURGH PA
15216-2129
US

V. Phone/Fax

Practice location:
  • Phone: 412-330-8440
  • Fax:
Mailing address:
  • Phone: 412-330-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018228
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: