Provider Demographics
NPI:1164445342
Name:HAMMONS, KIM HILDEBRAND (PHD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:HILDEBRAND
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1009
Mailing Address - Country:US
Mailing Address - Phone:305-378-5401
Mailing Address - Fax:305-378-5211
Practice Address - Street 1:1550 MADRUGA AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3039
Practice Address - Country:US
Practice Address - Phone:305-665-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 22121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3234OtherBLUE CROSS BLUE SHIELD
FLZ3234Medicare ID - Type Unspecified