Provider Demographics
NPI:1578778023
Name:HAUG, SIEGFRIED F (DMIN)
Entity Type:Individual
Prefix:DR
First Name:SIEGFRIED
Middle Name:F
Last Name:HAUG
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LAKE DRIVE
Mailing Address - Street 2:HAMMOND LAKE
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096
Mailing Address - Country:US
Mailing Address - Phone:413-268-0122
Mailing Address - Fax:
Practice Address - Street 1:720 HOPMEADOW STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070
Practice Address - Country:US
Practice Address - Phone:860-651-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11628822OtherCAQH
CT410000036CT01OtherANTHEM
CT000036OtherMFT LICENSE #