Provider Demographics
NPI:1316455876
Name:BERCOVICI, HILLARY REA (MDIV, PHD)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:REA
Last Name:BERCOVICI
Suffix:
Gender:M
Credentials:MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SOUND SHORE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-413-7804
Mailing Address - Fax:
Practice Address - Street 1:8 SOUND SHORE DR STE 130
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-413-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3090101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral