Provider Demographics
NPI:1427628031
Name:HILLIARD, RUSSELL E (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:E
Last Name:HILLIARD
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5421
Mailing Address - Country:US
Mailing Address - Phone:954-952-6194
Mailing Address - Fax:
Practice Address - Street 1:232 GARDEN CT
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5421
Practice Address - Country:US
Practice Address - Phone:954-952-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW126901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical