Provider Demographics
NPI:1750490421
Name:HAMM, ROBERT JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:HAMM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DUFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1214
Mailing Address - Country:US
Mailing Address - Phone:860-236-2131
Mailing Address - Fax:860-236-2131
Practice Address - Street 1:970 FARMINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2137
Practice Address - Country:US
Practice Address - Phone:860-236-2131
Practice Address - Fax:860-236-2131
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001254103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R39202Medicare UPIN