Provider Demographics
NPI:1457030082
Name:HILLIARD, JEROME (LISCW)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:HILLIARD
Suffix:
Gender:M
Credentials:LISCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 HALF ST SW APT 817
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3324
Mailing Address - Country:US
Mailing Address - Phone:202-367-4940
Mailing Address - Fax:
Practice Address - Street 1:1900 HALF ST SW APT 817
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3324
Practice Address - Country:US
Practice Address - Phone:202-367-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500828841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical