Provider Demographics
NPI:1801629860
Name:HAMPTON, LARRY LOUVERNE
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:LOUVERNE
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2058
Mailing Address - Country:US
Mailing Address - Phone:774-530-6363
Mailing Address - Fax:774-530-6364
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2058
Practice Address - Country:US
Practice Address - Phone:774-530-6363
Practice Address - Fax:774-530-6364
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator