Provider Demographics
NPI:1447007935
Name:HAMMERSTEIN, MARY KIPP (LMFT-A)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KIPP
Last Name:HAMMERSTEIN
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-1253
Mailing Address - Country:US
Mailing Address - Phone:224-770-1366
Mailing Address - Fax:
Practice Address - Street 1:50 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2711
Practice Address - Country:US
Practice Address - Phone:401-732-5656
Practice Address - Fax:401-738-8634
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00009-A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist