Provider Demographics
NPI:1558452326
Name:HAMMON, BRADY D (LCSW)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:D
Last Name:HAMMON
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 1:4860 ROBB ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2184
Mailing Address - Country:US
Mailing Address - Phone:303-446-7245
Mailing Address - Fax:888-341-5050
Practice Address - Street 1:404 N HORTON ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-6541
Practice Address - Country:US
Practice Address - Phone:208-466-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807675600Medicaid
IDLCSW-1131OtherPROFESSIONAL LICENSE
IDP01046676OtherRRCARE
ID807675600Medicaid