Provider Demographics
NPI:1548690225
Name:HAMILTON, DARA
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:
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:PO BOX 24603
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824-0603
Mailing Address - Country:US
Mailing Address - Phone:340-332-0414
Mailing Address - Fax:
Practice Address - Street 1:227 GOLDEN ROCK, OFFICE 1
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VT
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-474-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI07-024-PSY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical