Provider Demographics
NPI:1538261268
Name:HAAS, LAURA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:HAAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-0910
Mailing Address - Country:US
Mailing Address - Phone:516-753-3691
Mailing Address - Fax:516-454-0965
Practice Address - Street 1:201 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1824
Practice Address - Country:US
Practice Address - Phone:516-753-3691
Practice Address - Fax:516-454-0965
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070125-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN25A91Medicare ID - Type Unspecified