Provider Demographics
NPI:1609113042
Name:HAMLIN, GREGORY EDMUND
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDMUND
Last Name:HAMLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY E
Other - Middle Name:
Other - Last Name:HAMLIN PHD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:25050 AVENUE KEARNY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1255
Mailing Address - Country:US
Mailing Address - Phone:661-297-2326
Mailing Address - Fax:661-310-0075
Practice Address - Street 1:25050 AVENUE KEARNY
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1255
Practice Address - Country:US
Practice Address - Phone:661-297-2326
Practice Address - Fax:661-310-0075
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16871103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily