Provider Demographics
NPI:1326510157
Name:HAMMONS, MARTHA LETICIA (MSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LETICIA
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BECK AVE # MS 5-120
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6804
Mailing Address - Country:US
Mailing Address - Phone:707-784-8114
Mailing Address - Fax:707-428-6542
Practice Address - Street 1:275 BECK AVE # MS 5-120
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6804
Practice Address - Country:US
Practice Address - Phone:707-784-8114
Practice Address - Fax:707-428-6542
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW86566101YM0800X
CA880841041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical