Provider Demographics
NPI:1376084418
Name:HAELSIG, LAURA ANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:HAELSIG
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 1:3801 18TH AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-6148
Mailing Address - Country:US
Mailing Address - Phone:360-271-2501
Mailing Address - Fax:
Practice Address - Street 1:3801 18TH AVE APT 2E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-6148
Practice Address - Country:US
Practice Address - Phone:360-271-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician