1215047071 NPI number — HAMMOND FULLER BROWN LICSW

Table of content: HAMMOND FULLER BROWN LICSW (NPI 1215047071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215047071 NPI number — HAMMOND FULLER BROWN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
HAMMOND
Provider Middle Name:
FULLER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215047071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 WATER ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LACONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03246-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-528-6086
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 WATER ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-528-6086
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  487 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1039374 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30420183 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1406027Y0NH01 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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