Provider Demographics
NPI:1760548531
Name:HAAS, MADELEINE (LICSW)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-0914
Mailing Address - Country:US
Mailing Address - Phone:508-654-9400
Mailing Address - Fax:
Practice Address - Street 1:69 MILK ST
Practice Address - Street 2:SUITE 110A
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1225
Practice Address - Country:US
Practice Address - Phone:508-654-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1151911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001212201OtherMEDICARE PTAN