Provider Demographics
NPI:1356587570
Name:HAFER, RODERICK J (PHD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:J
Last Name:HAFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JAMESON DR
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-0108
Mailing Address - Country:US
Mailing Address - Phone:240-475-4884
Mailing Address - Fax:
Practice Address - Street 1:9 JAMESON DR
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-0108
Practice Address - Country:US
Practice Address - Phone:240-475-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2771103T00000X, 2084P0800X
MAPSY10000261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry