Provider Demographics
NPI:1497176150
Name:HAIT, ROXANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:HAIT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41191
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1191
Mailing Address - Country:US
Mailing Address - Phone:602-633-5474
Mailing Address - Fax:602-733-6471
Practice Address - Street 1:3420 E SHEA BLVD STE 188
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3354
Practice Address - Country:US
Practice Address - Phone:602-633-5474
Practice Address - Fax:602-733-6471
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4457OtherSTATE LICENSE