Provider Demographics
NPI:1497135933
Name:HILLS, AVALON (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:AVALON
Middle Name:
Last Name:HILLS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 FARRAGUT RD
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1933
Mailing Address - Country:US
Mailing Address - Phone:347-938-8090
Mailing Address - Fax:
Practice Address - Street 1:3622 FARRAGUT RD
Practice Address - Street 2:APT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1933
Practice Address - Country:US
Practice Address - Phone:347-938-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720936661041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool