Basic Information
| Provider Information | |||||||||
| NPI: | 1134658057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETKO | ||||||||
| FirstName: | HILLARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 COVINGTON DR | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142202811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163163730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2040 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142102324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168280560 | ||||||||
| FaxNumber: | 7168281522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2017 | ||||||||
| LastUpdateDate: | 02/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 092326 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.