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General NPI Number Information
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NPI Number | 1770154544
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Entity Type | Individual
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Provider Name | LYDIA ADY LISW
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Gender | Female
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 600 W 3RD ST
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City | MANSFIELD
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State | OH
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Zip | 44906-2633
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Country | US
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Telephone | 419-522-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 PARK AVE W STE 2
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City | ONTARIO
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State | OH
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Zip | 44906-2719
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2506356
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.175608
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2106413
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License Number State | OH
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