Healthcare Provider Details

I. General information

NPI: 1780856435
Provider Name (Legal Business Name): JENEVE VAHE CADDELL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENEVE VAHE PSY.D.

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 TECHNOLOGY WAY SUITE 4EA1
NASHUA NH
03060
US

IV. Provider business mailing address

80 TECHNOLOGY WAY SUITE 4EA1
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 646-704-3520
  • Fax:
Mailing address:
  • Phone: 646-704-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017518
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1312
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: