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General NPI Number Information
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NPI Number | 1104325695
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Entity Type | Organization
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Legal Business Name | MARY MITCHELL HADDAD PMHNP LLC
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 211 E 43RD ST RM 1305
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City | NEW YORK
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State | NY
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Zip | 10017-4779
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Country | US
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Telephone | 203-952-7571
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Fax | 212-642-5111
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Provider Business Mailing Address
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Address Line | 960 GREEN CIR
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City | ORANGE
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State | CT
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Zip | 06477-1736
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Country | US
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Telephone | 203-952-7571
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MS. MARY MITCHELL HADDAD
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Credential | RN, MSN, PMHNP
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Telephone | 203-952-7571
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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 | F402319-1
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License Number State | NY
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