Provider Demographics
NPI:1619132503
Name:HILL-LINDSAY, AUDREY (PHD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:HILL-LINDSAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7571
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7571
Mailing Address - Country:US
Mailing Address - Phone:310-909-7369
Mailing Address - Fax:424-603-2369
Practice Address - Street 1:1230 ROSECRANS AVE
Practice Address - Street 2:STE 300
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2494
Practice Address - Country:US
Practice Address - Phone:310-909-7369
Practice Address - Fax:424-603-2369
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020483103TC0700X
CAPSY22270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-3156477OtherEIN
26-3156477OtherEIN