Provider Demographics
NPI:1336220334
Name:HILL, MARY ANN (PHD)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:HILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 KELE ST
Mailing Address - Street 2:#201
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1803
Mailing Address - Country:US
Mailing Address - Phone:808-245-7225
Mailing Address - Fax:866-797-1194
Practice Address - Street 1:2970 KELE ST
Practice Address - Street 2:#201
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1803
Practice Address - Country:US
Practice Address - Phone:808-245-7225
Practice Address - Fax:866-797-1194
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH103140OtherMEDICARE
HI58209001Medicaid