Provider Demographics
NPI:1003482076
Name:HADDAD, DIANE (MA, MED, LPC, LCADC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HADDAD
Suffix:
Gender:
Credentials:MA, MED, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 DAFFODIL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4125
Mailing Address - Country:US
Mailing Address - Phone:908-461-6931
Mailing Address - Fax:
Practice Address - Street 1:19 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1466
Practice Address - Country:US
Practice Address - Phone:908-373-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00402300101YA0400X
NJ37PC01127400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)