Healthcare Provider Details

I. General information

NPI: 1720049943
Provider Name (Legal Business Name): MRS. KATHLEEN KERLEY HILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CAMINO REAL STE 401
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

7100 W CAMINO REAL STE 401
BOCA RATON FL
33433-5510
US

V. Phone/Fax

Practice location:
  • Phone: 954-360-9230
  • Fax:
Mailing address:
  • Phone: 954-360-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW1653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: