Healthcare Provider Details

I. General information

NPI: 1821756065
Provider Name (Legal Business Name): JESSICA LYN HADDAD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAMARONECK AVE STE 478
HARRISON NY
10528-1635
US

IV. Provider business mailing address

600 MAMARONECK AVE STE 478
HARRISON NY
10528-1635
US

V. Phone/Fax

Practice location:
  • Phone: 888-604-6776
  • Fax:
Mailing address:
  • Phone: 888-604-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28091
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11414601
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06688200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: