Provider Demographics
NPI:1366739641
Name:HILL, JERMAINE K (LMSW)
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:K
Last Name:HILL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 RICHMOND TERRACE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303
Mailing Address - Country:US
Mailing Address - Phone:347-668-4473
Mailing Address - Fax:347-466-5467
Practice Address - Street 1:1953 RICHMOND TERRACE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303
Practice Address - Country:US
Practice Address - Phone:347-668-4473
Practice Address - Fax:347-466-5467
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083062-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health