Provider Demographics
NPI:1902311756
Name:KADOSH, LILY VICTORIA (PSYD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:VICTORIA
Last Name:KADOSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 DUNWOODY CLUB DR STE 106 #196
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5421
Mailing Address - Country:US
Mailing Address - Phone:770-809-6995
Mailing Address - Fax:
Practice Address - Street 1:2090 DUNWOODY CLUB DR STE 106-196
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-5434
Practice Address - Country:US
Practice Address - Phone:770-809-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29337103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist