Provider Demographics
NPI:1174856884
Name:HAMPTON, KELLY OMEARA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:OMEARA
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5822
Mailing Address - Country:US
Mailing Address - Phone:561-927-7035
Mailing Address - Fax:
Practice Address - Street 1:299 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5822
Practice Address - Country:US
Practice Address - Phone:561-927-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-13
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 64201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical