Provider Demographics
NPI:1548598600
Name:HAEN, CRAIG MICHAEL (PHD, RDT, CGP, LCAT)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MICHAEL
Last Name:HAEN
Suffix:
Gender:M
Credentials:PHD, RDT, CGP, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3217
Mailing Address - Country:US
Mailing Address - Phone:917-439-7892
Mailing Address - Fax:
Practice Address - Street 1:510 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3217
Practice Address - Country:US
Practice Address - Phone:917-439-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000656221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist