Healthcare Provider Details

I. General information

NPI: 1912575192
Provider Name (Legal Business Name): CARLY J HILL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HENRY AVE # 302
PHILADELPHIA PA
19129-1141
US

IV. Provider business mailing address

128 CONESTOGA RD WAYNE PA ABT B
19087 PA
19087
US

V. Phone/Fax

Practice location:
  • Phone: 215-924-0684
  • Fax:
Mailing address:
  • Phone: 609-815-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW138102
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: