MEDICARE: KASEY HAMILTON

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1962978189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY HAMILTON

Provider Business Mailing Address
First Line	:	700 S CLAREMONT ST STE 110
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 S CLAREMONT ST STE 110
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1447
Country	:	US
Telephone Number	:	650-464-9378
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	10/15/2018

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Directions to “ KASEY HAMILTON ” Practice Location

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