Individual
DR. MARY LIDKEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.H.D.
Contact information
Practice address
2221 LEE RD, WINTER PARK, FL 32789-1864
(407) 628-5122
Mailing address
PO BOX 1362, WINTER PARK, FL 32790-1362
(407) 628-5122
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY3664
FL
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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