Provider Demographics
NPI:1508176264
Name:HAMIL, JANE C (CSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:HAMIL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:CLYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7431 114TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3761 VENTURE DRIVE
Practice Address - Street 2:
Practice Address - City:DELUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5528
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0013801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I808408Medicare PIN