Provider Demographics
NPI:1457517989
Name:HAMMET-KELLY, JUDITH ANNE
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANNE
Last Name:HAMMET-KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N PROVIDENCE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3527
Mailing Address - Country:US
Mailing Address - Phone:484-844-1166
Mailing Address - Fax:
Practice Address - Street 1:280 N PROVIDENCE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3527
Practice Address - Country:US
Practice Address - Phone:484-844-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006400-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist