Provider Demographics
NPI:1962001131
Name:HAMILTON, STEPHEN ISAAC
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ISAAC
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 ALANBROOKE ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-4960
Mailing Address - Country:US
Mailing Address - Phone:813-390-0712
Mailing Address - Fax:
Practice Address - Street 1:11602 N 51ST ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2132
Practice Address - Country:US
Practice Address - Phone:813-438-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst