Provider Demographics
NPI:1518956721
Name:BHATTACHARYA, LILIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:
Last Name:BHATTACHARYA
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 1:1825 HUMMOCK LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1943
Mailing Address - Country:US
Mailing Address - Phone:760-815-5470
Mailing Address - Fax:760-634-9703
Practice Address - Street 1:2101 S EL CAMINO REAL
Practice Address - Street 2:SUITE 207
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6227
Practice Address - Country:US
Practice Address - Phone:760-815-5470
Practice Address - Fax:760-634-9703
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10440103TC0700X
CA16580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA165800Medicaid
CACP16580Medicare ID - Type Unspecified