Provider Demographics
NPI:1902325111
Name:HILLIS-CLARK, PATRICIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:HILLIS-CLARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:HILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:655 SUGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3303
Mailing Address - Country:US
Mailing Address - Phone:484-595-6727
Mailing Address - Fax:
Practice Address - Street 1:655 SUGARTOWN ROAD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355
Practice Address - Country:US
Practice Address - Phone:484-595-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016610103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist