Provider Demographics
NPI:1124362595
Name:HAMILTON, AMY LOUISE (PSYD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 SASSAFRAS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:814-868-9828
Mailing Address - Fax:814-868-8561
Practice Address - Street 1:3413 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2678
Practice Address - Country:US
Practice Address - Phone:814-868-9828
Practice Address - Fax:814-868-8561
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004110101YM0800X
PA007768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health