Provider Demographics
NPI:1215708458
Name:HAMM, CARYN (CADC)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 ROOSTERS RD
Mailing Address - Street 2:
Mailing Address - City:PORT TREVORTON
Mailing Address - State:PA
Mailing Address - Zip Code:17864-9605
Mailing Address - Country:US
Mailing Address - Phone:570-850-7352
Mailing Address - Fax:
Practice Address - Street 1:2970 CORPORATE CT STE 1
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-3158
Practice Address - Country:US
Practice Address - Phone:570-850-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16597101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)