Provider Demographics
NPI:1790951903
Name:HASKINS, MARY PATRICIA (LCSW, LMHP, LADC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:HASKINS
Suffix:
Gender:F
Credentials:LCSW, LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E MILITARY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5490
Mailing Address - Country:US
Mailing Address - Phone:402-727-4886
Mailing Address - Fax:402-727-4146
Practice Address - Street 1:1627 E MILITARY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5490
Practice Address - Country:US
Practice Address - Phone:402-727-4886
Practice Address - Fax:402-727-4146
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE855101YA0400X
NE13691041C0700X
NE3724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1687OtherMEDICARE PTAN
NE10025687100Medicaid