Provider Demographics
NPI:1689738015
Name:HAMILTON, DALE ROBERT (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:ROBERT
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:D.
Other - Middle Name:ROBERT
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 2293
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-2293
Mailing Address - Country:US
Mailing Address - Phone:909-289-8927
Mailing Address - Fax:951-784-8813
Practice Address - Street 1:400 RAMONA AVE
Practice Address - Street 2:SUITE 212-L
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1440
Practice Address - Country:US
Practice Address - Phone:866-784-8813
Practice Address - Fax:951-784-8813
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist