MEDICARE: HILRY EVONNE HAZELWOOD

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	1041C0700X	Clinical Social Worker	44SC06029400	NJ
2	1041C0700X	Clinical Social Worker	087281	NY
3	1041C0700X	Clinical Social Worker	34359	MD

General Provider Information

NPI Number	:	1578999181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILRY EVONNE HAZELWOOD

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 MILLBURN AVE STE 101
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1941
Country	:	US
Telephone Number	:	201-632-5554
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	03/31/2026

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