Individual
MR. BLAKE HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
1300 W BELMONT AVE STE 211, CHICAGO, IL 60657-3240
(773) 880-2317
Mailing address
1300 W BELMONT AVE STE 211, CHICAGO, IL 60657-3240
(773) 880-2317
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149012143
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636966
BLUECROSS- BLUE SHIELD
IL
01
—
591278
VALUE OPTIONS
IL
01
—
600074695
MAGELLIAN
IL
Enumeration date
01/10/2007
Last updated
07/26/2010
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