Provider Demographics
NPI:1508957580
Name:HAFT, MAXINE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:S
Last Name:HAFT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WASHINGTON SQUARE VLG
Mailing Address - Street 2:APT PH F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1732
Mailing Address - Country:US
Mailing Address - Phone:212-674-5323
Mailing Address - Fax:
Practice Address - Street 1:15 SHERIDAN SQ
Practice Address - Street 2:SUITE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6847
Practice Address - Country:US
Practice Address - Phone:212-727-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004709103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV29832Medicare ID - Type Unspecified