Provider Demographics
NPI:1386851046
Name:HASLETT, CONSTANCE LORRAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:LORRAINE
Last Name:HASLETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SOUTHMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1813
Mailing Address - Country:US
Mailing Address - Phone:914-686-8178
Mailing Address - Fax:914-285-0591
Practice Address - Street 1:89 OLD MAMARONECK RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1903
Practice Address - Country:US
Practice Address - Phone:914-686-8178
Practice Address - Fax:914-285-0591
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7289103T00000X, 103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1318141OtherOXFORD
NY7329443-004OtherVALUE OPTIONS
NYP11012206OtherMULTIPLAN
NY016-22-146Medicaid
NY7329443-004OtherVALUE OPTIONS