1538231691 NPI number — DR. CAROL CHRISTINE HAMILTON PSYD

Table of content: MS. DEBBIE LEE ROBB (NPI 1982874376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538231691 NPI number — DR. CAROL CHRISTINE HAMILTON PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
CAROL
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538231691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97238-5970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-848-8560
Provider Business Mailing Address Fax Number:
503-296-2694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2613 NE MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97212-3761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-840-8560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1719 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201004027 . This is a "PHP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: N0607 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NN900NK28 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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