Provider Demographics
NPI:1679083745
Name:ZIVKOVIC, TANYA (LCSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ZIVKOVIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1143
Mailing Address - Country:US
Mailing Address - Phone:207-214-9520
Mailing Address - Fax:207-214-9520
Practice Address - Street 1:468 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1143
Practice Address - Country:US
Practice Address - Phone:207-214-9520
Practice Address - Fax:207-214-9520
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC186451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical