Provider Demographics
NPI:1073950796
Name:HAMM, BRADLEY K (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:K
Last Name:HAMM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 HARLEM RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4706
Mailing Address - Country:US
Mailing Address - Phone:716-421-6945
Mailing Address - Fax:
Practice Address - Street 1:3960 HARLEM RD STE 10
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4706
Practice Address - Country:US
Practice Address - Phone:716-421-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092754-1104100000X
NY086438-011041C0700X
NY0864381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker