Provider Demographics
NPI:1770323560
Name:MADDOCK, HALEY SKYE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:SKYE
Last Name:MADDOCK
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 1:430 RIVER ISLE CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3712
Mailing Address - Country:US
Mailing Address - Phone:321-987-8218
Mailing Address - Fax:
Practice Address - Street 1:1155 LOUISIANA AVE STE 216
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2351
Practice Address - Country:US
Practice Address - Phone:407-594-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health