Provider Demographics
NPI:1790975704
Name:HILL, JOHN WARREN (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARREN
Last Name:HILL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BLUE JAY WAY
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1333
Mailing Address - Country:US
Mailing Address - Phone:518-371-6385
Mailing Address - Fax:
Practice Address - Street 1:1 PINNACLE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3496
Practice Address - Country:US
Practice Address - Phone:518-689-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health