Healthcare Provider Details

I. General information

NPI: 1144590878
Provider Name (Legal Business Name): YADIRA BAEZ-LOCKARD PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COMMONS BLVD SUITE C
PIEDMONT SC
29673-7766
US

IV. Provider business mailing address

102 COMMONS BLVD SUITE C
PIEDMONT SC
29673-7766
US

V. Phone/Fax

Practice location:
  • Phone: 864-520-8152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1337
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1337
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: