Healthcare Provider Details

I. General information

NPI: 1831592872
Provider Name (Legal Business Name): HILLARY E SOUTHWICK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 07/16/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 BEEMAN WAY
CHAMPLAIN NY
12919-4965
US

IV. Provider business mailing address

PO BOX 1010
CHAMPLAIN NY
12919-1010
US

V. Phone/Fax

Practice location:
  • Phone: 315-203-5545
  • Fax:
Mailing address:
  • Phone: 315-203-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008099
License Number StateNY

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: