MEDICARE: AMARELLE HAMO PHD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC2200X	Clinical Child & Adolescent Psychologist	P121351	NY

General Provider Information

NPI Number	:	1225784382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARELLE HAMO PHD

Provider Business Mailing Address
First Line	:	36 GATEWAY DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1829
Country	:	US
Telephone Number	:	516-532-4424
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3913
Country	:	US
Telephone Number	:	212-305-3093
Fax Number	:

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

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	07/19/2023

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