Healthcare Provider Details

I. General information

NPI: 1801389697
Provider Name (Legal Business Name): MARJORIE JEAN HILL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DRIVE
ARVERNE NY
11692
US

IV. Provider business mailing address

6200 BEACH CHANNEL DRIVE
ARVERNE NY
11692
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-945-2596
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-945-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: