Provider Demographics
NPI:1356392401
Name:HAMILTON, JEFFREY D (MSSA DMIN LCSW)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MSSA DMIN LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E MCGOVERN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1923
Mailing Address - Country:US
Mailing Address - Phone:717-392-1007
Mailing Address - Fax:717-392-0827
Practice Address - Street 1:32 E MCGOVERN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-1923
Practice Address - Country:US
Practice Address - Phone:717-392-1007
Practice Address - Fax:717-392-0827
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0146351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50037505OtherCAPITAL BLUE CROSS
PA517420OtherVALUE OPTIONS