MEDICARE: DEBORAH HAMILTON LAC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1700493558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH HAMILTON LAC

Provider Business Mailing Address
First Line	:	42 ZAZZETTI ST
Second Line	:
City	:	WALDWICK
State	:	NJ
Zip	:	07463-1661
Country	:	US
Telephone Number	:	201-874-0771
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 W ALLENDALE AVE STE D
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1798
Country	:	US
Telephone Number	:	201-783-8436
Fax Number	:

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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