Basic Information
| Provider Information | |||||||||
| NPI: | 1871500579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADDICAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 WEST ESPLANADE AVE | ||||||||
| Address2: | STE 213 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385716 | ||||||||
| FaxNumber: | 5048385714 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 WESTBANK EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043498708 | ||||||||
| FaxNumber: | 5043298703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 3392B | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 1987751 | 05 | LA | MEDICAID |