Provider Demographics
NPI:1043767700
Name:NAVARRO, LILIANA
Entity type:Individual
Prefix:MS
First Name:LILIANA
Middle Name:
Last Name:NAVARRO
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 1:11335 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8627
Mailing Address - Country:US
Mailing Address - Phone:616-396-0623
Mailing Address - Fax:616-396-2315
Practice Address - Street 1:11335 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8627
Practice Address - Country:US
Practice Address - Phone:616-396-9556
Practice Address - Fax:616-396-2315
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851114388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362235165Medicaid