Provider Demographics
NPI:1700493558
Name:HAMILTON, DEBORAH (LAC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ZAZZETTI ST
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1661
Mailing Address - Country:US
Mailing Address - Phone:201-874-0771
Mailing Address - Fax:
Practice Address - Street 1:70 W ALLENDALE AVE STE D
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1798
Practice Address - Country:US
Practice Address - Phone:201-783-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty