MEDICARE: MS. SHAVONE HAMILTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	069910	NY

General Provider Information

NPI Number	:	1447335237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAVONE HAMILTON LCSW

Provider Business Mailing Address
First Line	:	6434 102ND ST
Second Line	:	SUITE 5O
City	:	REGO PARK
State	:	NY
Zip	:	11374-3650
Country	:	US
Telephone Number	:	718-275-4604
Fax Number	:

Provider Business Practice Location Address
First Line	:	2244 119TH ST
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2516
Country	:	US
Telephone Number	:	718-445-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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