Provider Demographics
NPI:1831264217
Name:HAMILTON, ELIZABETH B (PHD CLINICAL PSYCH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 D ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2768
Mailing Address - Country:US
Mailing Address - Phone:503-364-6093
Mailing Address - Fax:503-364-5121
Practice Address - Street 1:2250 D ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2768
Practice Address - Country:US
Practice Address - Phone:503-364-6093
Practice Address - Fax:503-364-5121
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1646103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist