Provider Demographics
NPI:1467713560
Name:HAIKEN, CHERYL MELISSA (MSSPED)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:MELISSA
Last Name:HAIKEN
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:MELISSA
Other - Last Name:NASSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSPED
Mailing Address - Street 1:60 THREEPENCE DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4022
Mailing Address - Country:US
Mailing Address - Phone:631-253-3005
Mailing Address - Fax:631-920-7360
Practice Address - Street 1:60 THREEPENCE DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4022
Practice Address - Country:US
Practice Address - Phone:631-253-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9879174400000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist