Provider Demographics
NPI:1760204762
Name:LILIENFELD, HUGO (REVEREND)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:LILIENFELD
Suffix:
Gender:M
Credentials:REVEREND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 EATON CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05658-7133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:657 EATON CEMETERY RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05658-7133
Practice Address - Country:US
Practice Address - Phone:917-685-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral