Provider Demographics
NPI:1073370268
Name:HAMILTON, KATIE (CT)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 STATE ROUTE 5 STE B
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9201
Mailing Address - Country:US
Mailing Address - Phone:330-282-4301
Mailing Address - Fax:330-282-4306
Practice Address - Street 1:2996 STATE ROUTE 5 STE B
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9201
Practice Address - Country:US
Practice Address - Phone:330-282-4301
Practice Address - Fax:330-282-4306
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305389-TRNE101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor