MEDICARE: PRISCILLA HILL HANEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	SW6996	FL
2	1041C0700X	Clinical Social Worker	SW6996	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528164001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA HILL HANEY LCSW

Provider Business Mailing Address
First Line	:	121 SEA GROVE MAIN ST UNIT 201
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-3303
Country	:	US
Telephone Number	:	904-347-4403
Fax Number	:	904-471-0639

Provider Business Practice Location Address
First Line	:	2225 A1A S STE B5
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-7906
Country	:	US
Telephone Number	:	904-347-4403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	02/27/2024

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