Provider Demographics
NPI:1760697486
Name:HAACK, ROBIN M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:HAACK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MANCHESTER AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1366
Mailing Address - Country:US
Mailing Address - Phone:609-339-5938
Mailing Address - Fax:609-549-5464
Practice Address - Street 1:34 MANCHESTER AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1366
Practice Address - Country:US
Practice Address - Phone:609-339-5938
Practice Address - Fax:609-549-5464
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052118001041C0700X, 104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health