Provider Demographics
NPI:1407463185
Name:HILLIARD, DAWYNE (CASAC LV LL)
Entity Type:Individual
Prefix:MR
First Name:DAWYNE
Middle Name:
Last Name:HILLIARD
Suffix:
Gender:M
Credentials:CASAC LV LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTH PORTLAND AVE
Mailing Address - Street 2:ROOM B225
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2005
Mailing Address - Country:US
Mailing Address - Phone:718-260-7786
Mailing Address - Fax:718-206-4801
Practice Address - Street 1:100 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2005
Practice Address - Country:US
Practice Address - Phone:718-260-7786
Practice Address - Fax:718-260-4801
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21196101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)