Healthcare Provider Details

I. General information

NPI: 1003427170
Provider Name (Legal Business Name): HADDONFIELD PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WASHINGTON AVE STE E-1
HADDONFIELD NJ
08033-3341
US

IV. Provider business mailing address

30 WASHINGTON AVE STE E-1
HADDONFIELD NJ
08033-3341
US

V. Phone/Fax

Practice location:
  • Phone: 856-300-2661
  • Fax:
Mailing address:
  • Phone: 856-300-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIELA M ANDRADE
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 856-300-2661