Provider Demographics
NPI:1790076255
Name:HAAG, STEPHANIE F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:F
Last Name:HAAG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MONTAUK HWY STE 112
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4429
Mailing Address - Country:US
Mailing Address - Phone:516-477-0086
Mailing Address - Fax:
Practice Address - Street 1:165 N VILLAGE AVE STE 112
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3701
Practice Address - Country:US
Practice Address - Phone:516-665-9669
Practice Address - Fax:516-665-9670
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018944-1103TS0200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool