Provider Demographics
NPI:1962503185
Name:HAAS, MATTHEW (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:HAAS
Suffix:
Gender:M
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 1221
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-1221
Mailing Address - Country:US
Mailing Address - Phone:413-250-8905
Mailing Address - Fax:413-534-2659
Practice Address - Street 1:151 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3128
Practice Address - Country:US
Practice Address - Phone:413-250-8905
Practice Address - Fax:413-534-2659
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10218481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2145993OtherCIGNA BEHAVIORAL HEALTH
MAP06419OtherBC/BS OF MA
MAHAP06419Medicare PIN