Healthcare Provider Details

I. General information

NPI: 1992203939
Provider Name (Legal Business Name): JENNIFER EULINE HAMILTON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 FORUM PL
WEST PALM BEACH FL
33401-2330
US

IV. Provider business mailing address

4605 N OCEAN BLVD
BOYNTON BEACH FL
33435-7356
US

V. Phone/Fax

Practice location:
  • Phone: 561-712-8821
  • Fax: 561-712-8821
Mailing address:
  • Phone: 561-215-2965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: