Provider Demographics
NPI:1174548267
Name:HILL, JANE A (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:A
Last Name:HILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-0605
Mailing Address - Country:US
Mailing Address - Phone:805-434-1375
Mailing Address - Fax:805-434-1716
Practice Address - Street 1:150 S 6TH ST
Practice Address - Street 2:SUITE C1
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2057
Practice Address - Country:US
Practice Address - Phone:805-481-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS179081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW179080Medicaid
CASW17908Medicare ID - Type Unspecified
CACSW179080Medicaid