Provider Demographics
NPI:1891419578
Name:HAMES, KORI ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:ELLEN
Last Name:HAMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7305
Mailing Address - Country:US
Mailing Address - Phone:203-308-3667
Mailing Address - Fax:
Practice Address - Street 1:123 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7404
Practice Address - Country:US
Practice Address - Phone:860-281-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0123611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical