Provider Demographics
NPI:1912367798
Name:KADOCH, TALY (LMHC)
Entity Type:Individual
Prefix:
First Name:TALY
Middle Name:
Last Name:KADOCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 NE 125TH STREET #210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181
Mailing Address - Country:US
Mailing Address - Phone:954-275-3023
Mailing Address - Fax:
Practice Address - Street 1:1966 NE 125TH STREET
Practice Address - Street 2:#210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181
Practice Address - Country:US
Practice Address - Phone:954-275-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health