Provider Demographics
NPI:1558760496
Name:HASKINS, NAOMI CAROLYN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:CAROLYN
Last Name:HASKINS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:CAROLYN
Other - Last Name:FRAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6944 IDSEN AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016
Mailing Address - Country:US
Mailing Address - Phone:763-438-7661
Mailing Address - Fax:
Practice Address - Street 1:7580 160TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8348
Practice Address - Country:US
Practice Address - Phone:952-898-1133
Practice Address - Fax:952-435-6797
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN203031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical