Provider Demographics
NPI:1154145506
Name:HAMILTON, CASEY (APSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N80W13004 FOND DU LAC AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-7204
Mailing Address - Country:US
Mailing Address - Phone:262-412-3030
Mailing Address - Fax:
Practice Address - Street 1:N80W13004 FOND DU LAC AVE APT 29
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-7204
Practice Address - Country:US
Practice Address - Phone:262-412-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135183121104100000X
103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty