MEDICARE: ANICKA HAMILTON

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1154932671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANICKA HAMILTON

Provider Business Mailing Address
First Line	:	208 WASHINGTON PARK
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4057
Country	:	US
Telephone Number	:	973-339-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 WASHINGTON PARK
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4057
Country	:	US
Telephone Number	:	973-339-0877
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	ANICKA HAMILTON
Credential	:	LCSW
Telephone Number	:	973-339-0877

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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