Active NPI
Todd Lee Hamilton, PSY.D.
- Clinical Psychologist
- Green Bay, WI
National Provider Identifier
1124154612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2287-057
- Practice address
- 2339 Cedar RDG
Green Bay, WI 54313-5700 - Phone
- (920) 497-6161
- Fax
- (920) 498-0476
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2287-057 | WI | Primary |
Addresses
Primary practice location
2339 Cedar RDG
Green Bay, WI 54313-5700
Mailing address
301 Seminole LN
Green Bay, WI 54313-4929
Phone (920) 819-6877
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39133500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2287-057 | WI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovative Counseling Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Green Bay, WI
- NPI 1093869588
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124154612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 SEMINOLE LN",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543134929",
"telephone_number": "920-819-6877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2339 CEDAR RDG",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543135700",
"telephone_number": "920-497-6161",
"fax_number": "920-498-0476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAMILTON",
"first_name": "TODD",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "2287-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39133500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.