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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 7 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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