Provider Demographics
NPI:1992368195
Name:HALL, LILY (PHD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:HALL
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 1:45 CREEKSIDE LN UNIT 238
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3269
Mailing Address - Country:US
Mailing Address - Phone:401-524-7172
Mailing Address - Fax:
Practice Address - Street 1:45 CREEKSIDE LN UNIT 238
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3269
Practice Address - Country:US
Practice Address - Phone:401-524-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018015694103T00000X
PAPS019189103T00000X
NY023306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist