Provider Demographics
NPI:1134109820
Name:HADDIX, CASEY RANDALL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:RANDALL
Last Name:HADDIX
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 STATE ROAD 436
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6485
Mailing Address - Country:US
Mailing Address - Phone:407-740-0007
Mailing Address - Fax:407-740-8360
Practice Address - Street 1:1211 STATE ROAD 436
Practice Address - Street 2:SUITE 113
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6485
Practice Address - Country:US
Practice Address - Phone:407-740-0007
Practice Address - Fax:407-740-8360
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7175103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75247AMedicare ID - Type Unspecified