Provider Demographics
NPI:1356656003
Name:HILTZ, DANIELLE T (LMSW-CC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:T
Last Name:HILTZ
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 HALLOWELL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04222-5216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:654 HALLOWELL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:ME
Practice Address - Zip Code:04222-5216
Practice Address - Country:US
Practice Address - Phone:207-353-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC112661041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool