Provider Demographics
NPI:1700194545
Name:HAAKE, SABINE A (MARD)
Entity Type:Individual
Prefix:MRS
First Name:SABINE
Middle Name:A
Last Name:HAAKE
Suffix:
Gender:F
Credentials:MARD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 TAMALPAIS DR
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1417
Mailing Address - Country:US
Mailing Address - Phone:415-924-4457
Mailing Address - Fax:415-927-4250
Practice Address - Street 1:150 NELLEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1104
Practice Address - Country:US
Practice Address - Phone:415-924-4457
Practice Address - Fax:415-927-4250
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA805457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst