Provider Demographics
NPI:1609319516
Name:LUMAJ, BLERINA (MA,TLLP)
Entity Type:Individual
Prefix:MRS
First Name:BLERINA
Middle Name:
Last Name:LUMAJ
Suffix:
Gender:F
Credentials:MA,TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47724 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2544
Mailing Address - Country:US
Mailing Address - Phone:586-552-6268
Mailing Address - Fax:
Practice Address - Street 1:11111 HALL RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5711
Practice Address - Country:US
Practice Address - Phone:586-552-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical