Provider Demographics
NPI:1043271000
Name:HAMILTON, SANDRA E (LCSW R)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:OYONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW R
Mailing Address - Street 1:27 ACORN LANE
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-421-9233
Mailing Address - Fax:
Practice Address - Street 1:611 COUNTY ROAD 42
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:NY
Practice Address - Zip Code:14453
Practice Address - Country:US
Practice Address - Phone:585-924-0430
Practice Address - Fax:585-924-0289
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0450211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02396023Medicaid
NY02396023Medicaid