Healthcare Provider Details

I. General information

NPI: 1487088142
Provider Name (Legal Business Name): ELIZABETH HILDERBRAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E MAIN ST
BLOOMFIELD IN
47424-1460
US

IV. Provider business mailing address

PO BOX 4323
TERRE HAUTE IN
47804-0323
US

V. Phone/Fax

Practice location:
  • Phone: 812-384-9452
  • Fax: 812-384-9445
Mailing address:
  • Phone: 812-231-8323
  • Fax: 812-231-8102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007414A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

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: