Provider Demographics
NPI:1215003421
Name:STAMM, ERIC GREGORY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:GREGORY
Last Name:STAMM
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 1:500 VINE STREET
Mailing Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER HUMAN RESOURCES
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:860-297-0905
Mailing Address - Fax:860-297-0914
Practice Address - Street 1:500 VINE STREET
Practice Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER HUMAN RESOURCES
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-297-0905
Practice Address - Fax:860-297-0914
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical