Provider Demographics
NPI:1811164445
Name:HAMMOND, BRADFORD MARSHALL (LCMHC)
Entity type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:MARSHALL
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:EAST DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05253-0722
Mailing Address - Country:US
Mailing Address - Phone:802-867-7070
Mailing Address - Fax:802-362-9924
Practice Address - Street 1:38 DORSET VILLAGE LN
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:VT
Practice Address - Zip Code:05251
Practice Address - Country:US
Practice Address - Phone:802-867-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000389101YM0800X
VT068-0000389101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006836Medicaid