Healthcare Provider Details

I. General information

NPI: 1770681553
Provider Name (Legal Business Name): LIDIA CARDONE PH.D. CLINICAL PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN STREET SUITE 100-43
HILTON HEAD ISLAND SC
29926-2762
US

IV. Provider business mailing address

400 MAIN STREET SUITE 100-43
HILTON HEAD ISLAND SC
29926-2762
US

V. Phone/Fax

Practice location:
  • Phone: 843-816-9533
  • Fax:
Mailing address:
  • Phone: 843-816-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1848
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00004892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: