Provider Demographics
NPI:1366060485
Name:HAMMERAND, SUSAN MARIE (LBA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:HAMMERAND
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 E WASHINGTON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-7439
Mailing Address - Country:US
Mailing Address - Phone:602-773-5773
Mailing Address - Fax:602-273-9108
Practice Address - Street 1:1471 N ELISEO FELIX JR WAY
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1208
Practice Address - Country:US
Practice Address - Phone:602-609-4221
Practice Address - Fax:602-273-9108
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001898103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst