Healthcare Provider Details

I. General information

NPI: 1285156257
Provider Name (Legal Business Name): JEFFREY T. HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 NORTHWEST DR
PLAINVILLE CT
06062-1534
US

IV. Provider business mailing address

395 BRITTANY FARMS RD APT 129
NEW BRITAIN CT
06053-1156
US

V. Phone/Fax

Practice location:
  • Phone: 860-793-3500
  • Fax:
Mailing address:
  • Phone: 860-794-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2959
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: