Healthcare Provider Details

I. General information

NPI: 1285748087
Provider Name (Legal Business Name): BLANCHE OLIVIA HILL LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL RD
WALTON NY
13856-1454
US

IV. Provider business mailing address

1 HOSPITAL RD
WALTON NY
13856-1454
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-6522
  • Fax: 607-865-7424
Mailing address:
  • Phone: 607-865-6522
  • Fax: 607-865-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: