Provider Demographics
NPI:1235388836
Name:LULGJURAJ, KATHERINE (BS)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:LULGJURAJ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 BEVERLY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3674
Mailing Address - Country:US
Mailing Address - Phone:248-773-1326
Mailing Address - Fax:313-893-0064
Practice Address - Street 1:329 BEVERLY ESTATES DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3674
Practice Address - Country:US
Practice Address - Phone:248-773-1326
Practice Address - Fax:313-893-0064
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid