Provider Demographics
NPI:1609020999
Name:HISLOP, ATREYOUIL M
Entity Type:Individual
Prefix:MR
First Name:ATREYOUIL
Middle Name:M
Last Name:HISLOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 KINGS COLLEGE PL
Mailing Address - Street 2:APARTMENT 3C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1532
Mailing Address - Country:US
Mailing Address - Phone:917-862-0973
Mailing Address - Fax:
Practice Address - Street 1:3555 KINGS COLLEGE PL
Practice Address - Street 2:APARTMENT 3C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1532
Practice Address - Country:US
Practice Address - Phone:917-862-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069347104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker