Provider Demographics
NPI:1164821435
Name:LAURA HAAS LCSW & ASSOCIATES
Entity Type:Organization
Organization Name:LAURA HAAS LCSW & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-753-3691
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:11758-1869
Practice Address - Country:US
Practice Address - Phone:516-753-3691
Practice Address - Fax:516-454-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0701251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02930138Medicaid
NY02930138Medicaid