Basic Information
| Provider Information | |||||||||
| NPI: | 1013038116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HADDOCK | ||||||||
| FirstName: | YADIRAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 HAVILAND STREET | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609850457 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 896 ASYLUM AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605228241 | ||||||||
| FaxNumber: | 8605248143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.