Provider Demographics
NPI:1326569120
Name:MITCHELL HADDAD, MARY ELLEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:MITCHELL HADDAD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:MITCHELL HADDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, PMHNP
Mailing Address - Street 1:211 E 43RD ST RM 1305
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4779
Mailing Address - Country:US
Mailing Address - Phone:646-899-8237
Mailing Address - Fax:
Practice Address - Street 1:211 E 43RD ST RM 1305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4779
Practice Address - Country:US
Practice Address - Phone:646-899-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353420-1163W00000X
CT88186163W00000X
NY402319363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse