Provider Demographics
NPI:1912319294
Name:HAMILTON, JORDAN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 EAST ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5119
Mailing Address - Country:US
Mailing Address - Phone:530-889-0178
Mailing Address - Fax:530-889-8279
Practice Address - Street 1:128 EAST ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5119
Practice Address - Country:US
Practice Address - Phone:530-889-0178
Practice Address - Fax:530-889-8279
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14481103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist