MEDICARE: MISS COSETTE ANNETTE HAMPTON B.A.

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist

General Provider Information

NPI Number	:	1215300272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS COSETTE ANNETTE HAMPTON B.A.

Provider Business Mailing Address
First Line	:	530 WEST 187 STREET
Second Line	:	JUST ONE BREAK INC
City	:	NEW YORK CITY
State	:	NY
Zip	:	10033-1437
Country	:	US
Telephone Number	:	609-347-6256
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 WEST 187 STREET
Second Line	:	JUST ONE BREAK INC
City	:	NEW YORK CITY
State	:	NY
Zip	:	10033-1437
Country	:	US
Telephone Number	:	609-347-6256
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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