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NPI Code Detail

MEDICARE: DR. LYDIA BALLINGER PHD

MEDICARE: DR. LYDIA BALLINGER PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1336966340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYDIA BALLINGER PHD
Provider Business Mailing Address
First Line : 7165 CREEKBEND DR
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-9729
Country : US
Telephone Number : 716-696-2248
Fax Number :
Provider Business Practice Location Address
First Line : 6350 MAIN ST
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-5821
Country : US
Telephone Number : 716-783-3221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2024
Last Update Date : 02/10/2026

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