Provider Demographics
NPI:1437637717
Name:DR. DRAGA ILIEVSKI PH.D. LCSW
Entity type:Organization
Organization Name:DR. DRAGA ILIEVSKI PH.D. LCSW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:DRAGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILIEVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW
Authorized Official - Phone:219-464-8811
Mailing Address - Street 1:5 WASHINGTON ST STE 250
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4769
Mailing Address - Country:US
Mailing Address - Phone:219-464-8811
Mailing Address - Fax:219-464-8819
Practice Address - Street 1:5 WASHINGTON ST STE 250
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4769
Practice Address - Country:US
Practice Address - Phone:219-464-8811
Practice Address - Fax:219-464-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004858A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty