Provider Demographics
NPI:1649381260
Name:HAMMER, JOHANNA (LICSW)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:HAMMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COLLEGE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1421
Mailing Address - Country:US
Mailing Address - Phone:413-534-7400
Mailing Address - Fax:413-534-7400
Practice Address - Street 1:9 COLLEGE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1421
Practice Address - Country:US
Practice Address - Phone:413-534-7400
Practice Address - Fax:413-534-7483
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO8086OtherBLUE SHIELD
MA464915OtherTUFTS
MAPO8086OtherBLUE SHIELD