MEDICARE: HOLLOW HILLS LICENSED CLINICAL SOCIAL WORK P.C.

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	104100000X	Social Worker	R054186-1	NY

General Provider Information

NPI Number	:	1346495710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLOW HILLS LICENSED CLINICAL SOCIAL WORK P.C.

Provider Business Mailing Address
First Line	:	31 MELROSE RD
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5610
Country	:	US
Telephone Number	:	631-573-0311
Fax Number	:	631-673-0313

Provider Business Practice Location Address
First Line	:	31 MELROSE RD
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5610
Country	:	US
Telephone Number	:	631-425-1168
Fax Number	:	631-673-0313

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARILYN FENTY
Credential	:
Telephone Number	:	631-673-0311

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	03/11/2026

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