Provider Demographics
NPI:1548603608
Name:OSIPOV, LILYA (PHD)
Entity Type:Individual
Prefix:
First Name:LILYA
Middle Name:
Last Name:OSIPOV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2011
Mailing Address - Country:US
Mailing Address - Phone:408-550-6303
Mailing Address - Fax:
Practice Address - Street 1:518 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2011
Practice Address - Country:US
Practice Address - Phone:408-550-6303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical