Provider Demographics
NPI:1629847553
Name:HAMILTON, ANGELINA M (LISW)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4780 LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1487
Mailing Address - Country:US
Mailing Address - Phone:216-346-1765
Mailing Address - Fax:
Practice Address - Street 1:4780 LITCHFIELD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1487
Practice Address - Country:US
Practice Address - Phone:216-346-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23048341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical