Provider Demographics
NPI:1508992710
Name:HAAPANEN, RANDY MATT (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:MATT
Last Name:HAAPANEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 LOTT RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-9703
Mailing Address - Country:US
Mailing Address - Phone:530-877-2730
Mailing Address - Fax:530-891-4670
Practice Address - Street 1:1430 EAST AVE STE 4C
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1629
Practice Address - Country:US
Practice Address - Phone:530-877-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5845103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL58450OtherBLUE SHIELD PROVIDER NUMB
CA156186OtherVALUE OPTIONS PROV NUMB
CA00PL58450Medicare ID - Type UnspecifiedNHIC CORP
CA156186OtherVALUE OPTIONS PROV NUMB