Provider Demographics
NPI:1427934066
Name:HAMILTON, JAYA M
Entity type:Individual
Prefix:
First Name:JAYA
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20761 RIDGEDALE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2703
Mailing Address - Country:US
Mailing Address - Phone:313-398-1423
Mailing Address - Fax:313-398-1423
Practice Address - Street 1:20761 RIDGEDALE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2703
Practice Address - Country:US
Practice Address - Phone:313-398-1423
Practice Address - Fax:313-398-1423
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-10-7852106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician