MEDICARE: MARCIA AMANDA HILLARY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY12057	CA

General Provider Information

NPI Number	:	1174793756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA AMANDA HILLARY PHD

Provider Business Mailing Address
First Line	:	1024 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8013
Country	:	US
Telephone Number	:	916-990-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8013
Country	:	US
Telephone Number	:	916-990-7733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	12/16/2011

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