Healthcare Provider Details

I. General information

NPI: 1578768925
Provider Name (Legal Business Name): HAMILTON & HAMILTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2007
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 RUCKER RD SUITE B
INDIANAPOLIS IN
46220-4887
US

IV. Provider business mailing address

6308 RUCKER RD SUITE B
INDIANAPOLIS IN
46220-4887
US

V. Phone/Fax

Practice location:
  • Phone: 317-713-1216
  • Fax: 317-465-9689
Mailing address:
  • Phone: 317-713-1216
  • Fax: 317-465-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20041611A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004896A
License Number StateIN

VIII. Authorized Official

Name: MRS. TAMARA KAE HAMILTON
Title or Position: PRESIDENT
Credential: LCSW
Phone: 317-713-1216