Provider Demographics
NPI:1780856435
Name:CADDELL, JENEVE VAHE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENEVE
Middle Name:VAHE
Last Name:CADDELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENEVE
Other - Middle Name:
Other - Last Name:VAHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:80 TECHNOLOGY WAY
Mailing Address - Street 2:SUITE 4EA1
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:646-704-3520
Mailing Address - Fax:
Practice Address - Street 1:80 TECHNOLOGY WAY
Practice Address - Street 2:SUITE 4EA1
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:646-704-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017518103TC0700X
NH1312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical