Provider Demographics
NPI:1093571960
Name:HILLER, MARILYN NMI (LCSW-32496)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:NMI
Last Name:HILLER
Suffix:
Gender:F
Credentials:LCSW-32496
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:NMI
Other - Last Name:BARTLOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:208-463-0118
Mailing Address - Fax:208-463-1507
Practice Address - Street 1:508 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-463-0118
Practice Address - Fax:208-463-1507
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-32496101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)