Provider Demographics
NPI:1225354194
Name:HAMILTON, POLLY REMAL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:REMAL
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:POLLY
Other - Middle Name:REMAL
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:16987 NW 19 STREET
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028
Mailing Address - Country:US
Mailing Address - Phone:954-441-5466
Mailing Address - Fax:
Practice Address - Street 1:3500 N. STATE ROAD 7 SUITE 211
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5625
Practice Address - Country:US
Practice Address - Phone:954-578-8399
Practice Address - Fax:954-578-0145
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical