Provider Demographics
NPI:1467698365
Name:OGASAWARA, LILIKO (LCADC,PC)
Entity Type:Individual
Prefix:MS
First Name:LILIKO
Middle Name:
Last Name:OGASAWARA
Suffix:
Gender:F
Credentials:LCADC,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 W PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2611
Mailing Address - Country:US
Mailing Address - Phone:201-567-0500
Mailing Address - Fax:201-384-7067
Practice Address - Street 1:2 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628
Practice Address - Country:US
Practice Address - Phone:201-385-4400
Practice Address - Fax:201-384-7067
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00134000101YA0400X
NJ37PC00377000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ696702Medicare PIN