Provider Demographics
NPI:1619939931
Name:HAMILTON, RICHARD A (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 MADRUGA AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3040
Mailing Address - Country:US
Mailing Address - Phone:305-669-4455
Mailing Address - Fax:305-665-5899
Practice Address - Street 1:1570 MADRUGA AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3040
Practice Address - Country:US
Practice Address - Phone:305-669-4455
Practice Address - Fax:305-665-5899
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3864103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTH000Medicare UPIN
FL73332Medicare ID - Type Unspecified