Provider Demographics
NPI:1326299728
Name:HAMILTON, LAUREL A (MA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1619 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4015
Mailing Address - Country:US
Mailing Address - Phone:714-420-6944
Mailing Address - Fax:714-992-5259
Practice Address - Street 1:1619 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4015
Practice Address - Country:US
Practice Address - Phone:714-420-6944
Practice Address - Fax:714-992-5259
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist