1114062817 NPI number — MRS. NANCY HENDRICKSON HADDAD LMHC

Table of content: MRS. NANCY HENDRICKSON HADDAD LMHC (NPI 1114062817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114062817 NPI number — MRS. NANCY HENDRICKSON HADDAD LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDAD
Provider First Name:
NANCY
Provider Middle Name:
HENDRICKSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HADDAD
Provider Other First Name:
NAN
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114062817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 CHELSEA ST
Provider Second Line Business Mailing Address:
29 BAXTER STREET
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-393-0831
Provider Business Mailing Address Fax Number:
781-395-0217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
173 CHELSEA ST
Provider Second Line Business Practice Location Address:
TRI CITY MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02149-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-388-6242
Provider Business Practice Location Address Fax Number:
617-387-1089
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4383 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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