Provider Demographics
NPI:1457039083
Name:HADDOCK, BRITTANY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:BARKHAMSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06063-3436
Mailing Address - Country:US
Mailing Address - Phone:203-437-2185
Mailing Address - Fax:
Practice Address - Street 1:9815 CROSS PINE CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2367
Practice Address - Country:US
Practice Address - Phone:203-437-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician