Provider Demographics
NPI:1366670127
Name:HAMILTON PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:HAMILTON PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRENDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-226-2822
Mailing Address - Street 1:37399 GARFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3672
Mailing Address - Country:US
Mailing Address - Phone:586-226-2822
Mailing Address - Fax:586-226-2833
Practice Address - Street 1:37399 GARFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3672
Practice Address - Country:US
Practice Address - Phone:586-226-2822
Practice Address - Fax:586-226-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007382103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP60520Medicare PIN
MIR83671Medicare UPIN