MEDICARE: ANGELINA M HAMILTON LISW

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	1041C0700X	Clinical Social Worker	I.2304834	OH

General Provider Information

NPI Number	:	1629847553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELINA M HAMILTON LISW

Provider Business Mailing Address
First Line	:	4780 LITCHFIELD DR
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1487
Country	:	US
Telephone Number	:	216-346-1765
Fax Number	:

Provider Business Practice Location Address
First Line	:	4780 LITCHFIELD DR
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1487
Country	:	US
Telephone Number	:	216-346-1765
Fax Number	:

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

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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