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General NPI Number Information
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NPI Number | 1407284904
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Entity Type | Individual
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Provider Name | LYDIA C RICHARDSON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 609
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City | CHICAGO
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State | IL
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Zip | 60601-7511
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Country | US
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Telephone | 708-288-5216
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Fax |
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Provider Business Mailing Address
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Address Line | 3270 N LAKE SHORE DR APT 13D
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City | CHICAGO
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State | IL
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Zip | 60657-3921
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Country | US
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Telephone | 708-288-5216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008689
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License Number State | IL
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