Provider Demographics
NPI:1447504931
Name:MILICEVIC, TASIA (LCSW)
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:
Last Name:MILICEVIC
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:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-0924
Mailing Address - Country:US
Mailing Address - Phone:201-528-5757
Mailing Address - Fax:201-322-3738
Practice Address - Street 1:861 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4907
Practice Address - Country:US
Practice Address - Phone:201-528-5757
Practice Address - Fax:201-322-3738
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
NJ44SC058349001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health