Provider Demographics
NPI:1295858397
Name:PAVLINOVIC, LILLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LILLY
Middle Name:
Last Name:PAVLINOVIC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LJILJANA
Other - Middle Name:
Other - Last Name:PAVLINOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:309 E 4TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6911
Mailing Address - Country:US
Mailing Address - Phone:646-236-6364
Mailing Address - Fax:
Practice Address - Street 1:1133 BROADWAY
Practice Address - Street 2:SUITE 807
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7903
Practice Address - Country:US
Practice Address - Phone:646-236-6364
Practice Address - Fax:212-777-5194
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019288103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300056984Medicare PIN