Provider Demographics
NPI:1871308841
Name:PETKOSKA GJORGIOSKA, MARIJA
Entity type:Individual
Prefix:
First Name:MARIJA
Middle Name:
Last Name:PETKOSKA GJORGIOSKA
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 1:1620 EDITH WAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9191
Mailing Address - Country:US
Mailing Address - Phone:219-702-2921
Mailing Address - Fax:
Practice Address - Street 1:8401 OHIO
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6687
Practice Address - Country:US
Practice Address - Phone:219-525-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-23-285018106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician