Healthcare Provider Details

I. General information

NPI: 1407192016
Provider Name (Legal Business Name): HARVEY DARNELL HAMM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 ARENA DR. SUITE 460-E
LARGO MD
20774-8949
US

IV. Provider business mailing address

14706 HAWLEY LN
UPPER MARLBORO MD
20774-8949
US

V. Phone/Fax

Practice location:
  • Phone: 240-601-9963
  • Fax:
Mailing address:
  • Phone: 240-601-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078370
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13247
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HARVEY DARNELL HAMM
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW-C, LICSW
Phone: 240-601-9963