Provider Demographics
NPI:1053737361
Name:HILBERG, JASON (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HILBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 OAK GROVE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4440
Mailing Address - Country:US
Mailing Address - Phone:650-289-9078
Mailing Address - Fax:650-322-3716
Practice Address - Street 1:855 OAK GROVE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4440
Practice Address - Country:US
Practice Address - Phone:650-289-9078
Practice Address - Fax:650-322-3716
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16579103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent