Healthcare Provider Details

I. General information

NPI: 1295721363
Provider Name (Legal Business Name): DAVID MARK HADDAD ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GINGER BREAD LN
ASHBURNHAM MA
01430-1272
US

IV. Provider business mailing address

3 GINGER BREAD LN
ASHBURNHAM MA
01430-1272
US

V. Phone/Fax

Practice location:
  • Phone: 978-827-5499
  • Fax: 978-827-4497
Mailing address:
  • Phone: 978-827-5499
  • Fax: 978-827-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6460
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: