Provider Demographics
NPI:1043242043
Name:HAMILTON, CAROL LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:491 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2636
Mailing Address - Country:US
Mailing Address - Phone:207-831-3434
Mailing Address - Fax:207-839-3690
Practice Address - Street 1:491 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2636
Practice Address - Country:US
Practice Address - Phone:207-831-3434
Practice Address - Fax:207-839-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 5017104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker