Provider Demographics
NPI:1295311363
Name:HAAG-FISK, MEGAN P (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:P
Last Name:HAAG-FISK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PEMBERWICK RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5042
Mailing Address - Country:US
Mailing Address - Phone:646-299-1395
Mailing Address - Fax:
Practice Address - Street 1:254B MILL ST # A3
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5808
Practice Address - Country:US
Practice Address - Phone:646-299-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086174-1104100000X
CT0104061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker