Provider Demographics
NPI:1972952018
Name:HAMMELMAN, SPENCER (LCSW)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:HAMMELMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3109
Mailing Address - Country:US
Mailing Address - Phone:279-434-8407
Mailing Address - Fax:727-943-4845
Practice Address - Street 1:3142 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691
Practice Address - Country:US
Practice Address - Phone:727-943-4840
Practice Address - Fax:727-943-4845
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW15702101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100923700Medicaid