Idicula, Jerry George
Idicula, Jerry George is an individual health care provider with primary practice located at 1332 Maryland St , Grosse Pointe Park MI 48230. He recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as his primary health care specialty. Idicula, Jerry George can be contacted via phone (313) 288-9458.Contact Information
Primary practice address
1332 Maryland St
Grosse Pointe Park MI 48230
Phone: (313) 288-9458
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X | 1-19-34854 | Michigan |
Profile Details
| NPI number | 1356711766 |
|---|---|
| LBN Legal business name | Idicula, Jerry George |
| Credentials | M.ED., BCBA |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 28th, 2015 |
| Last updated | Mar 27th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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