Provider Demographics
NPI:1942735485
Name:DEMIROVIC, MERSIHA
Entity Type:Individual
Prefix:
First Name:MERSIHA
Middle Name:
Last Name:DEMIROVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LEHMAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6515
Mailing Address - Country:US
Mailing Address - Phone:270-393-9833
Mailing Address - Fax:270-393-9835
Practice Address - Street 1:1011 LEHMAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6515
Practice Address - Country:US
Practice Address - Phone:270-393-9833
Practice Address - Fax:270-393-9835
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
KY2529061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical