Provider Demographics
NPI:1447335237
Name:HAMILTON, SHAVONE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHAVONE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6434 102ND ST
Mailing Address - Street 2:SUITE 5O
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3650
Mailing Address - Country:US
Mailing Address - Phone:718-275-4604
Mailing Address - Fax:
Practice Address - Street 1:2244 119TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2516
Practice Address - Country:US
Practice Address - Phone:718-445-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0699101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical