Provider Demographics
NPI:1124493754
Name:HADDEN, ANITA RAINA RAJ (MA)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:RAINA RAJ
Last Name:HADDEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RECORD ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5418
Mailing Address - Country:US
Mailing Address - Phone:301-620-8700
Mailing Address - Fax:
Practice Address - Street 1:116 RECORD ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5418
Practice Address - Country:US
Practice Address - Phone:301-620-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist