MEDICARE: JOHN WILKES HAMMOND II LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102503	MA

General Provider Information

NPI Number	:	1639226509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILKES HAMMOND II LICSW

Provider Business Mailing Address
First Line	:	118 LONG POND RD
Second Line	:	SUITE106
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2662
Country	:	US
Telephone Number	:	508-747-6762
Fax Number	:	508-747-1315

Provider Business Practice Location Address
First Line	:	118 LONG POND RD
Second Line	:	SUITE106
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2662
Country	:	US
Telephone Number	:	508-747-6762
Fax Number	:	508-747-1315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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