Provider Demographics
NPI:1184864910
Name:HAMILTON, COURTNEY CLAIRE (MS, RD, L/DN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CLAIRE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS, RD, L/DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ENDICOTT AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4157
Mailing Address - Country:US
Mailing Address - Phone:330-883-6408
Mailing Address - Fax:
Practice Address - Street 1:205 ENDICOTT AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4157
Practice Address - Country:US
Practice Address - Phone:330-883-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered