Provider Demographics
NPI:1457356487
Name:HAMMERBECK, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HAMMERBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:HAMMERBECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2780 JEFFERSON CENTRE WAY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8293
Mailing Address - Country:US
Mailing Address - Phone:812-288-8622
Mailing Address - Fax:812-288-8632
Practice Address - Street 1:2780 JEFFERSON CENTRE WAY UNIT 104
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8293
Practice Address - Country:US
Practice Address - Phone:812-288-8622
Practice Address - Fax:812-288-8632
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059001A2084P0800X
KY267372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200331410Medicaid
INE39172Medicare UPIN