Provider Demographics
NPI:1922025097
Name:HILMO, JO ELLEN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JO ELLEN
Middle Name:MARIE
Last Name:HILMO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JO ELLEN
Other - Middle Name:MARIE
Other - Last Name:MCRAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20980 REDWOOD RD
Mailing Address - Street 2:STE. 230
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5930
Mailing Address - Country:US
Mailing Address - Phone:510-889-8645
Mailing Address - Fax:
Practice Address - Street 1:20980 REDWOOD RD
Practice Address - Street 2:STE. 230
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5930
Practice Address - Country:US
Practice Address - Phone:510-889-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY8230OtherPSYCHOLOGY LICENSE
CAPSY8230OtherPSYCHOLOGY LICENSE