Healthcare Provider Details

I. General information

NPI: 1861491292
Provider Name (Legal Business Name): MICHAEL HAMMER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 CUDAHY PL SUITE 314
SAN DIEGO CA
92110-3931
US

IV. Provider business mailing address

1094 CUDAHY PL SUITE 314
SAN DIEGO CA
92110-3931
US

V. Phone/Fax

Practice location:
  • Phone: 619-276-8812
  • Fax: 619-276-8230
Mailing address:
  • Phone: 619-276-8812
  • Fax: 619-276-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number068678-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004243
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 24859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: