1174323562 NPI number — MARY JANE HILL LCPC CONDITIONAL

Table of content: MARY JANE HILL LCPC CONDITIONAL (NPI 1174323562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174323562 NPI number — MARY JANE HILL LCPC CONDITIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
MARY
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC CONDITIONAL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BILLMAN
Provider Other First Name:
MARY
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174323562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN BUREN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04785-0025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-484-8453
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 STATE ST STE 613
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-307-7704
Provider Business Practice Location Address Fax Number:
207-573-1108
Provider Enumeration Date:
03/15/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  XL8029 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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