Provider Demographics
NPI:1073967881
Name:ELIZABETH B. HAIMAN, LCSW, CORP
Entity Type:Organization
Organization Name:ELIZABETH B. HAIMAN, LCSW, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BRANDT
Authorized Official - Last Name:HAIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-913-8313
Mailing Address - Street 1:1000 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2042
Mailing Address - Country:US
Mailing Address - Phone:850-913-8313
Mailing Address - Fax:850-913-8314
Practice Address - Street 1:1000 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2042
Practice Address - Country:US
Practice Address - Phone:850-913-8313
Practice Address - Fax:850-913-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5WIXROtherFLORIDA BLUE