Provider Demographics
NPI:1912575192
Name:HILL, CARLY J (LSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:J
Last Name:HILL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CONESTOGA RD WAYNE PA
Mailing Address - Street 2:ABT B
Mailing Address - City:19087
Mailing Address - State:PA
Mailing Address - Zip Code:19087
Mailing Address - Country:US
Mailing Address - Phone:609-815-6384
Mailing Address - Fax:
Practice Address - Street 1:3300 HENRY AVE # 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1141
Practice Address - Country:US
Practice Address - Phone:215-924-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138102104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker