Provider Demographics
NPI:1154376630
Name:HAMDI, MARK ELWOOD (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELWOOD
Last Name:HAMDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 COUNTY ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-2419
Mailing Address - Country:US
Mailing Address - Phone:518-499-2696
Mailing Address - Fax:518-761-2044
Practice Address - Street 1:5 WARREN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4558
Practice Address - Country:US
Practice Address - Phone:518-761-9977
Practice Address - Fax:518-761-2044
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
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