| Doctor Name: | DR. JACOB EDWARD HADDEN |
| NPI Number: | 1336496983 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 048.0092013 |
| Business Practice Address: | 2038 Saranac Ave Lake Placid, NY - 129461177 |
| Business Phone Number: | 5185885173 |
| Business Fax Number: | 8452054454 |
| Mailing Address: | Po Box 1202, LAKE PLACID |
| State: | NY |
| Postal Code: | 129465202 |
| Phone Number: | 5185885173 |
| Fax Number: | 8452054454 |
| NPI Enumeration Date: | 08/13/2012 |
| NPI Last Update Date: | 09/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 048.0092013 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |