Provider Demographics
NPI:1629096706
Name:HAMILTON-GAHART, TERRI (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:
Last Name:HAMILTON-GAHART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BROOKWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5258
Mailing Address - Country:US
Mailing Address - Phone:707-525-1958
Mailing Address - Fax:707-525-1924
Practice Address - Street 1:101 BROOKWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5258
Practice Address - Country:US
Practice Address - Phone:707-525-1958
Practice Address - Fax:707-525-1924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12336103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY123360Medicaid
CAPSY123360Medicaid