Healthcare Provider Details

I. General information

NPI: 1144976275
Provider Name (Legal Business Name): DIANA HAMM LPC, ATR-BC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S BROAD ST # 3F
PHILADELPHIA PA
19148-2216
US

IV. Provider business mailing address

1901 S BROAD ST # 3F
PHILADELPHIA PA
19148-2216
US

V. Phone/Fax

Practice location:
  • Phone: 215-800-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC014104
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number21-161
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: