Provider Demographics
NPI:1700462017
Name:KRICHEVSKY, LYDIA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:KRICHEVSKY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:480-478-0444
Mailing Address - Fax:602-854-7422
Practice Address - Street 1:3303 N 44TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:480-478-0444
Practice Address - Fax:602-854-7422
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001305103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst