Active NPI
Mary Lidkea, P.H.D.
- Clinical Psychologist
- Winter Park, FL
National Provider Identifier
1356469290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY3664
- Practice address
- 2221 Lee Rd
Winter Park, FL 32789-1864 - Phone
- (407) 628-5122
- NPI assigned
- Mar 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY3664 | FL | Primary |
Addresses
Primary practice location
2221 Lee Rd
Winter Park, FL 32789-1864
Mailing address
PO Box 1362
Winter Park, FL 32790-1362
Phone (407) 628-5122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY3664 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356469290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1362",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327901362",
"telephone_number": "407-628-5122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2221 LEE RD",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327891864",
"telephone_number": "407-628-5122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDKEA",
"first_name": "MARY",
"name_prefix": "Dr.",
"credential": "P.H.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY3664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
- Hannah McWilliams Lewis, DO
- Khadijah Lewis
- Lorisa P. Lewis, MS, LMHC
- Tonya Maria Lewis, LPN
- Vicki Marie Lewis, M.A., CCC-SLP
- Life Counseling Professional Services
- Life Enhancement Series, Inc.
- Lifeline Connect Nurse Consulting4
- Lifting Individual and Family Expectations, Inc.
- Lifting Individual and Family Expectations, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.