Provider Demographics
NPI:1104135532
Name:HILLEBERT, PAUL FREDERICK (LCSWC-C, LCADC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDERICK
Last Name:HILLEBERT
Suffix:
Gender:M
Credentials:LCSWC-C, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S POTOMAC ST APT 301
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5537
Mailing Address - Country:US
Mailing Address - Phone:240-469-9991
Mailing Address - Fax:
Practice Address - Street 1:28 S POTOMAC ST
Practice Address - Street 2:#305
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6194
Practice Address - Country:US
Practice Address - Phone:240-469-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA418101YA0400X
MD127221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442810200Medicaid