Healthcare Provider Details

I. General information

NPI: 1700546744
Provider Name (Legal Business Name): HILL YOURSELF THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BLOOMING GROVE TPKE
NEW WINDSOR NY
12553-7843
US

IV. Provider business mailing address

PO BOX 2066
NEWBURGH NY
12550-0250
US

V. Phone/Fax

Practice location:
  • Phone: 845-742-1801
  • Fax:
Mailing address:
  • Phone: 845-742-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SYRETTA HILL
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW, CASAC
Phone: 845-742-1801