Basic Information
| Provider Information | |||||||||
| NPI: | 1912575192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | CARLY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 CONESTOGA RD WAYNE PA | ||||||||
| Address2: | ABT B | ||||||||
| City: | 19087 | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098156384 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 HENRY AVE # 302 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191291141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159240684 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2021 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW138102 | PA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.