Provider Demographics
NPI:1649475468
Name:HILL, KATHLEEN L (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:L
Last Name:HILL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950-23 BLANDING BOULEVARD
Mailing Address - Street 2:221
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:904-853-0791
Mailing Address - Fax:
Practice Address - Street 1:950-23 BLANDING BOULEVARD
Practice Address - Street 2:221
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:904-853-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2020-11-25
Deactivation Date:2016-05-24
Deactivation Code:
Reactivation Date:2020-11-10
Provider Licenses
StateLicense IDTaxonomies
FLSW 75981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical