Healthcare Provider Details

I. General information

NPI: 1215708458
Provider Name (Legal Business Name): CARYN HAMM CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CORPORATE CT STE 1
OREFIELD PA
18069-3158
US

IV. Provider business mailing address

256 ROOSTERS RD
PORT TREVORTON PA
17864-9605
US

V. Phone/Fax

Practice location:
  • Phone: 570-850-7352
  • Fax:
Mailing address:
  • Phone: 570-850-7352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16597
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: