Provider Demographics
NPI:1205925039
Name:HAAK, JENNIFER L (MD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:HAAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1435
Mailing Address - Country:US
Mailing Address - Phone:716-828-9655
Mailing Address - Fax:716-828-9745
Practice Address - Street 1:650 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1435
Practice Address - Country:US
Practice Address - Phone:716-828-9655
Practice Address - Fax:716-828-9745
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2271492084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry