Provider Demographics
NPI:1649529405
Name:ENDRES, LILIYA
Entity type:Individual
Prefix:
First Name:LILIYA
Middle Name:
Last Name:ENDRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIYA
Other - Middle Name:IVANIVNA
Other - Last Name:GRYTSYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:93 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3933
Mailing Address - Country:US
Mailing Address - Phone:203-772-1270
Mailing Address - Fax:203-772-0051
Practice Address - Street 1:93 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3933
Practice Address - Country:US
Practice Address - Phone:203-772-1270
Practice Address - Fax:203-772-0051
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent