Provider Demographics
NPI:1235351081
Name:HILLIARD, PETER LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:LAWRENCE
Last Name:HILLIARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24117 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-4003
Mailing Address - Country:US
Mailing Address - Phone:951-242-3709
Mailing Address - Fax:
Practice Address - Street 1:13800 HEACOCK ST
Practice Address - Street 2:SUITE 133
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3339
Practice Address - Country:US
Practice Address - Phone:951-656-7318
Practice Address - Fax:951-656-3269
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 74751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical