MEDICARE: KELLY E HAMILTON LMHC, CPT

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	3405-1	NY

General Provider Information

NPI Number	:	1568594521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY E HAMILTON LMHC, CPT

Provider Business Mailing Address
First Line	:	12 W GENESEE ST
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-1105
Country	:	US
Telephone Number	:	315-857-3934
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 W GENESEE ST
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-1105
Country	:	US
Telephone Number	:	315-857-3934
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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