Provider Demographics
NPI:1407279557
Name:HADDEN, THERESE (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:HADDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:THERESE
Other - Middle Name:ANN
Other - Last Name:RUANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2489 RICKER ROAD
Mailing Address - Street 2:FORT BLISS
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920
Mailing Address - Country:US
Mailing Address - Phone:915-742-4781
Mailing Address - Fax:915-742-3482
Practice Address - Street 1:2489 RICKER ROAD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:915-742-4781
Practice Address - Fax:915-742-3482
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390451041C0700X
MI68010576141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39045OtherLICENSED CLINICAL SOCIAL WORKER
MI6801057614OtherCLINICAL AND MACRO LICENSE