Provider Demographics
NPI:1639288608
Name:HILLEBRAND, MARY MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:HILLEBRAND
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 1:27288 APPLE BLOSSOM LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1048
Mailing Address - Country:US
Mailing Address - Phone:248-355-4834
Mailing Address - Fax:248-945-1002
Practice Address - Street 1:27288 APPLE BLOSSOM LANE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1048
Practice Address - Country:US
Practice Address - Phone:248-355-4834
Practice Address - Fax:248-945-1002
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI140832OtherCARE CHOICE
MI353123OtherMHN
MIP1510923Other1ST HEALTH
MI5233178OtherMAGELLAN
MI043351OtherVALUE OPTIONS
MI680F33178OtherBLUE CROSS
MIP1510923OtherOXFORD HEALTH
MI112243OtherUNITED BEHAVIORAL HEALTH
MI0005233178OtherAETNA
MI0M54420Medicare ID - Type Unspecified
MI0005233178OtherAETNA