Provider Demographics
NPI:1184097446
Name:PICCO, LYDIA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:ANN
Last Name:PICCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 STEINWAY ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1866
Mailing Address - Country:US
Mailing Address - Phone:203-231-9160
Mailing Address - Fax:
Practice Address - Street 1:2219 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1866
Practice Address - Country:US
Practice Address - Phone:203-231-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092526-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical