Provider Demographics
NPI:1699324558
Name:HAMILTON, GEORGETTE MARIEATTA (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:MARIEATTA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:MRS
Other - First Name:JOY
Other - Middle Name:MARIEATTA
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4804 WILLES VISION DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4671
Mailing Address - Country:US
Mailing Address - Phone:301-792-5071
Mailing Address - Fax:
Practice Address - Street 1:1425 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4618
Practice Address - Country:US
Practice Address - Phone:301-792-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCSW13765103K00000X
DCLC500803791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst