Provider Demographics
NPI:1679165336
Name:BERISHAJ, ALICIA MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:BERISHAJ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:PAVLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1841 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-2235
Mailing Address - Country:US
Mailing Address - Phone:248-745-4900
Mailing Address - Fax:
Practice Address - Street 1:1841 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2235
Practice Address - Country:US
Practice Address - Phone:248-745-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801108856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker