Provider Demographics
NPI:1861567273
Name:HILLBRAND, MARC (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:HILLBRAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 BARNES RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-6012
Mailing Address - Country:US
Mailing Address - Phone:203-294-0094
Mailing Address - Fax:860-262-5477
Practice Address - Street 1:1062 BARNES RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-6012
Practice Address - Country:US
Practice Address - Phone:203-294-0094
Practice Address - Fax:860-262-5477
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001402CT01OtherANTHEM BCBS PRACTICE ID