Provider Demographics
NPI:1225811565
Name:HAMMOND, KEVIN JEROME (MSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JEROME
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CALDER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5637
Mailing Address - Country:US
Mailing Address - Phone:504-994-7542
Mailing Address - Fax:
Practice Address - Street 1:1400 CALDER ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5637
Practice Address - Country:US
Practice Address - Phone:504-994-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13389251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty