Provider Demographics
NPI:1821756065
Name:HADDAD, JESSICA LYN (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYN
Last Name:HADDAD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAMARONECK AVE STE 478
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1635
Mailing Address - Country:US
Mailing Address - Phone:888-604-6776
Mailing Address - Fax:
Practice Address - Street 1:600 MAMARONECK AVE STE 478
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1635
Practice Address - Country:US
Practice Address - Phone:888-604-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD280911041C0700X
NY114146011041C0700X
NJ44SL066882001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical