Provider Demographics
NPI:1376644963
Name:HAMILTON, LISA-LINDA LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA-LINDA
Middle Name:LEE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S STATE ST STE S-2300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84190-2250
Mailing Address - Country:US
Mailing Address - Phone:801-468-2007
Mailing Address - Fax:
Practice Address - Street 1:2001 S STATE ST STE S-2300
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84190-2250
Practice Address - Country:US
Practice Address - Phone:801-468-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141501-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical