Provider Demographics
NPI:1972210607
Name:HAGGERTY, ALEXANDER ROBERT
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ROBERT
Last Name:HAGGERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SETTLERS LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1877
Mailing Address - Country:US
Mailing Address - Phone:860-519-7855
Mailing Address - Fax:
Practice Address - Street 1:12 SETTLERS LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1877
Practice Address - Country:US
Practice Address - Phone:860-519-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician