Provider Demographics
NPI:1982207551
Name:HAAS, JAIME MICHELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MICHELLE
Last Name:HAAS
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 1:639 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1606
Mailing Address - Country:US
Mailing Address - Phone:845-800-8649
Mailing Address - Fax:
Practice Address - Street 1:639 N PEARL ST
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-1606
Practice Address - Country:US
Practice Address - Phone:845-800-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist