=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538231691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL CHRISTINE HAMILTON PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 10/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2613 NE MARTIN LUTHER KING JR BLVD STE A
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97212-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-840-8560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 55970
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97238-5970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-848-8560
-----------------------------------------------------
Fax | 503-296-2694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1719
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------