Provider Demographics
NPI:1871168195
Name:HADDEN, BRIANNA VIRGINIA JEANETTE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:VIRGINIA JEANETTE
Last Name:HADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FOULKSTONE PLAZA 1405 FOULK ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILIMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:610-457-6779
Mailing Address - Fax:
Practice Address - Street 1:FOULKSTONE PLAZA 1405 FOULK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILIMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:484-441-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-20-44560103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst