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General NPI Number Information
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NPI Number | 1558883538
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Entity Type | Individual
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Provider Name | SONYA HARSHA LYDICK PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 4500 CLEARVIEW PKWY STE 201
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City | METAIRIE
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State | LA
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Zip | 70006-2351
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Country | US
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Telephone | 504-885-1442
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Fax | 504-885-1441
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Provider Business Mailing Address
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Address Line | 4500 CLEARVIEW PKWY STE 201
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City | METAIRIE
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State | LA
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Zip | 70006-2351
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Country | US
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Telephone | 504-885-1442
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Fax | 504-885-1441
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1566
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5166
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License Number State | NE
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