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General NPI Number Information
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NPI Number | 1083080725
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Entity Type | Organization
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Legal Business Name | HADDONFIELD PSYCHIATRIC ASSOCIATES LLC
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 31 TANNER ST
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City | HADDONFIELD
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State | NJ
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Zip | 08033-2403
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Country | US
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Telephone | 856-428-7646
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Fax |
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Provider Business Mailing Address
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Address Line | 127 N HINCHMAN AVE
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City | HADDONFIELD
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State | NJ
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Zip | 08033-2725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | JUSTIN FADEN
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Credential |
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Telephone | 732-330-0332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 25MB08863700
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License Number State | NJ
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