Provider Demographics
NPI:1053645226
Name:HILL, PATRICIA KATHLEEN
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KATHLEEN
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:KATHLEEN
Other - Last Name:HILL-MAKITALO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2580 E MAIN ST
Mailing Address - Street 2:100
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2646
Mailing Address - Country:US
Mailing Address - Phone:818-207-5859
Mailing Address - Fax:818-991-0534
Practice Address - Street 1:2580 E MAIN ST
Practice Address - Street 2:100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2646
Practice Address - Country:US
Practice Address - Phone:818-207-5859
Practice Address - Fax:818-991-0534
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist