Healthcare Provider Details

I. General information

NPI: 1477270064
Provider Name (Legal Business Name): LYDIA LOZANO LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYDIA ROSARIO LISW-CP

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 REMOUNT RD OFC 3E
NORTH CHARLESTON SC
29406-3320
US

IV. Provider business mailing address

1495 REMOUNT RD OFC 3E
NORTH CHARLESTON SC
29406-3320
US

V. Phone/Fax

Practice location:
  • Phone: 843-259-2843
  • Fax: 843-400-1962
Mailing address:
  • Phone: 843-259-2843
  • Fax: 843-400-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15104
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: