Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 37LC00118000 | NJ |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00118000 | NJ |
N | 101YM0800X | Mental Health Counselor | 37AC00086900 | NJ |
N | 101YP1600X | Pastoral Counselor | 37CL00118000 | NJ |
N | 1041C0700X | Clinical Social Worker | 44SC05363800 | NJ |
N | 207RA0401X | Internist - Addiction Medicine | 37LC00118000 | NJ |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NO106752 | NJ |
NPI | 1366685554 |
---|---|
Provider Name | Mr. Henry Duane Hamilton I |
First Address | East Orange, NJ 07018-2106 |
Second Address | East Orange, NJ 07018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0490717 | (05) | NJ |
0491187 | (05) | NJ |
11890384 | CAQH (01) | NJ |
8576195 | AETNA (01) | NJ |