Provider Demographics
NPI:1952483927
Name:HAAS, CAROLYN KAY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:KAY
Last Name:HAAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:KAY
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:801 HAZEN STREET PO BOX 249
Mailing Address - Street 2:SUITE C
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-657-3474
Practice Address - Street 1:1007 EAST WELLS STREET
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9612
Practice Address - Country:US
Practice Address - Phone:269-637-5297
Practice Address - Fax:269-637-9238
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087741104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
H06346029Medicare PIN