Provider Demographics
NPI:1679583298
Name:NIKOLOVSKA, LIDIJA M (LMSW CSW)
Entity Type:Individual
Prefix:MRS
First Name:LIDIJA
Middle Name:M
Last Name:NIKOLOVSKA
Suffix:
Gender:F
Credentials:LMSW CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19598 KATHRON CR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138
Mailing Address - Country:US
Mailing Address - Phone:248-245-1130
Mailing Address - Fax:734-642-3424
Practice Address - Street 1:19598 KATHRON CR
Practice Address - Street 2:
Practice Address - City:GROSSE
Practice Address - State:MI
Practice Address - Zip Code:48138
Practice Address - Country:US
Practice Address - Phone:517-265-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010677351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008974190OtherBCBS
0M76710Medicare ID - Type Unspecified
MI8008974190OtherBCBS