Provider Demographics
NPI:1558460006
Name:HAYMAKER, STEPHANIE (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HAYMAKER
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:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:OLDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08858-0242
Mailing Address - Country:US
Mailing Address - Phone:908-439-3456
Mailing Address - Fax:908-439-2343
Practice Address - Street 1:48 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:OLDWICK
Practice Address - State:NJ
Practice Address - Zip Code:08858
Practice Address - Country:US
Practice Address - Phone:908-439-3456
Practice Address - Fax:908-439-2343
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
044825Medicare ID - Type Unspecified