Provider Demographics
NPI:1336153766
Name:DOMERS, HILLARY S (LCSW)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:S
Last Name:DOMERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1625
Mailing Address - Country:US
Mailing Address - Phone:215-877-2000
Mailing Address - Fax:215-581-9195
Practice Address - Street 1:4200 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-1625
Practice Address - Country:US
Practice Address - Phone:215-877-2000
Practice Address - Fax:215-581-9195
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW0077590L1041C0700X
NJ44SC047961001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ005122CYOMedicare ID - Type Unspecified