Provider Demographics
NPI:1144609140
Name:JOSEPHSON, HALEY CLARK (LMT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:CLARK
Last Name:JOSEPHSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CANAL PL
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365
Mailing Address - Country:US
Mailing Address - Phone:315-985-8556
Mailing Address - Fax:
Practice Address - Street 1:410 CANAL PL
Practice Address - Street 2:SUITE 207
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365
Practice Address - Country:US
Practice Address - Phone:315-985-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist