Basic Information
| Provider Information | |||||||||
| NPI: | 1124362595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 SASSAFRAS ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165022716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148689828 | ||||||||
| FaxNumber: | 8148688561 | ||||||||
| Practice Location | |||||||||
| Address1: | 3413 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148689828 | ||||||||
| FaxNumber: | 8148688561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2012 | ||||||||
| LastUpdateDate: | 11/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC004110 | GA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 007768 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.