Provider Demographics
NPI:1861689994
Name:HAMILTON, ELLEN (L C S W)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:L C S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32345-0488
Mailing Address - Country:US
Mailing Address - Phone:850-997-7275
Mailing Address - Fax:
Practice Address - Street 1:5877 NORTH SALT ROAD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344
Practice Address - Country:US
Practice Address - Phone:850-997-7275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762837400Medicaid