Provider Demographics
NPI:1689970204
Name:HAUG, INGEBORG (DMIN)
Entity Type:Individual
Prefix:DR
First Name:INGEBORG
Middle Name:
Last Name:HAUG
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 VESPER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4335
Mailing Address - Country:US
Mailing Address - Phone:203-368-8581
Mailing Address - Fax:203-368-0066
Practice Address - Street 1:144 VESPER ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4335
Practice Address - Country:US
Practice Address - Phone:203-368-8581
Practice Address - Fax:203-368-0066
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist