Provider Demographics
NPI:1285324384
Name:BORODKIN, LILIYA (LSW, MSW)
Entity type:Individual
Prefix:MS
First Name:LILIYA
Middle Name:
Last Name:BORODKIN
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:MS
Other - First Name:LILIYA
Other - Middle Name:
Other - Last Name:TANENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 JARMAN PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5580
Mailing Address - Country:US
Mailing Address - Phone:973-280-4149
Mailing Address - Fax:
Practice Address - Street 1:39 JARMAN PL
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-5580
Practice Address - Country:US
Practice Address - Phone:973-280-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05590400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker