Provider Demographics
NPI:1265774244
Name:KOVALEVICH, LILIYA A (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LILIYA
Middle Name:A
Last Name:KOVALEVICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RUSSET BUSH LN
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5531
Mailing Address - Country:US
Mailing Address - Phone:315-794-4834
Mailing Address - Fax:
Practice Address - Street 1:628 MARY ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2419
Practice Address - Country:US
Practice Address - Phone:315-794-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker