Individual
MS. CHRISTINE LIDZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1641 DURHAM RD, GUILFORD, CT 06437-1639
(203) 671-4402
Mailing address
1641 DURHAM RD, GUILFORD, CT 06437-1639
(203) 671-4402
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
001787
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004039244
—
CT
01
—
140001787CT01
ANTHEM PROVIDER NUMBER
CT
01
—
191083
MANAGED HEALTH NETWORK
CT
Enumeration date
07/17/2006
Last updated
02/23/2022
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