Provider Demographics
NPI:1114062817
Name:HADDAD, NANCY HENDRICKSON (LMHC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:HENDRICKSON
Last Name:HADDAD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:NAN
Other - Middle Name:H
Other - Last Name:HADDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:173 CHELSEA ST
Mailing Address - Street 2:29 BAXTER STREET
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-393-0831
Mailing Address - Fax:781-395-0217
Practice Address - Street 1:173 CHELSEA ST
Practice Address - Street 2:TRI CITY MENTAL HEALTH CENTER
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-4632
Practice Address - Country:US
Practice Address - Phone:781-388-6242
Practice Address - Fax:617-387-1089
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health