Provider Demographics
NPI:1154157196
Name:HAMMALIAN, CONNOR THOMAS
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:THOMAS
Last Name:HAMMALIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 PASCACK RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7948
Mailing Address - Country:US
Mailing Address - Phone:201-661-0052
Mailing Address - Fax:
Practice Address - Street 1:53 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1832
Practice Address - Country:US
Practice Address - Phone:973-773-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00863300101Y00000X
NJ2024-000326101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)