Provider Demographics
NPI:1235213836
Name:SHIDLOVSKI, LILI (MFT)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:SHIDLOVSKI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:SHIDLOVSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1443 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2015
Mailing Address - Country:US
Mailing Address - Phone:415-824-8353
Mailing Address - Fax:415-285-9953
Practice Address - Street 1:1443 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2015
Practice Address - Country:US
Practice Address - Phone:415-824-8353
Practice Address - Fax:415-285-9953
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT7916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist