Provider Demographics
NPI:1396360822
Name:HILLER, LEVI YITZCHAK (LMSW)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:YITZCHAK
Last Name:HILLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15540 GEORGE WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3038
Mailing Address - Country:US
Mailing Address - Phone:414-759-0251
Mailing Address - Fax:
Practice Address - Street 1:17200 W 10 MILE RD STE 213
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-8200
Practice Address - Country:US
Practice Address - Phone:414-759-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011066901041C0700X
MI68011144491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical