Provider Demographics
NPI:1508321985
Name:CAROL PHILLIPS HAMILTON LCSW PC
Entity Type:Organization
Organization Name:CAROL PHILLIPS HAMILTON LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA CPC
Authorized Official - Phone:708-560-6653
Mailing Address - Street 1:2052 W OHIO ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1516
Mailing Address - Country:US
Mailing Address - Phone:773-531-1529
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 626
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3444
Practice Address - Country:US
Practice Address - Phone:773-531-1529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty