=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477529816
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNETTE S WIDGEON-HAMMONDS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2006
-----------------------------------------------------
Last Update Date | 12/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 INDEPENDENCE PKWY 100
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-420-0530
-----------------------------------------------------
Fax | 757-420-0488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5324 ALTON DR
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-420-0530
-----------------------------------------------------
Fax | 757-420-0488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904001785
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------