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General NPI Number Information
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NPI Number | 1821756065
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Entity Type | Individual
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Provider Name | JESSICA LYN HADDAD LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 600 MAMARONECK AVE STE 478
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City | HARRISON
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State | NY
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Zip | 10528-1635
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Country | US
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Telephone | 888-604-6776
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Fax |
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Provider Business Mailing Address
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Address Line | 600 MAMARONECK AVE STE 478
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City | HARRISON
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State | NY
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Zip | 10528-1635
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Country | US
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Telephone | 888-604-6776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28091
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11414601
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL06688200
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License Number State | NJ
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