Provider Demographics
NPI:1558488221
Name:HAMMEL, MARK (PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HAMMEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4335
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-4335
Mailing Address - Country:US
Mailing Address - Phone:845-339-2352
Mailing Address - Fax:845-943-2271
Practice Address - Street 1:31 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-2717
Practice Address - Country:US
Practice Address - Phone:845-339-2352
Practice Address - Fax:845-943-2271
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY137247OtherVALUEOPTIONS
NY01004342Medicaid
NY965240OtherMVP HEALTHCARE
NY01004342Medicaid