Provider Demographics
NPI:1598437386
Name:HALLER, ENID I (LCSW PHD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:
Last Name:HALLER
Suffix:I
Gender:F
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 FOX LN # 118
Mailing Address - Street 2:
Mailing Address - City:QUECHEE
Mailing Address - State:VT
Mailing Address - Zip Code:05059-3141
Mailing Address - Country:US
Mailing Address - Phone:508-560-1893
Mailing Address - Fax:
Practice Address - Street 1:85 FOX LN # 118
Practice Address - Street 2:
Practice Address - City:QUECHEE
Practice Address - State:VT
Practice Address - Zip Code:05059-3141
Practice Address - Country:US
Practice Address - Phone:508-560-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052744-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical