Provider Demographics
NPI:1740973973
Name:HADDAD, KIM NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:NICOLE
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 1:1521 W LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-1205
Mailing Address - Country:US
Mailing Address - Phone:623-999-0160
Mailing Address - Fax:
Practice Address - Street 1:1521 W LEWIS AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1205
Practice Address - Country:US
Practice Address - Phone:623-999-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088234104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker