Provider Demographics
NPI:1659778967
Name:EADDY, NADANIEL JR
Entity Type:Individual
Prefix:MR
First Name:NADANIEL
Middle Name:
Last Name:EADDY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 RIDGE AVE
Mailing Address - Street 2:APT B145
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3053
Mailing Address - Country:US
Mailing Address - Phone:609-531-5374
Mailing Address - Fax:
Practice Address - Street 1:2600 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2040
Practice Address - Country:US
Practice Address - Phone:609-531-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist