Provider Demographics
NPI:1124213764
Name:AGUSTIN, HILDY KELLMAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HILDY
Middle Name:KELLMAN
Last Name:AGUSTIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 MENLO AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4751
Mailing Address - Country:US
Mailing Address - Phone:650-321-1788
Mailing Address - Fax:650-321-8845
Practice Address - Street 1:830 MENLO AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4751
Practice Address - Country:US
Practice Address - Phone:650-321-1788
Practice Address - Fax:650-321-8845
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19060103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL190600Medicare UPIN