Provider Demographics
NPI:1720075526
Name:HAGGERTY, SEAN BARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:BARRY
Last Name:HAGGERTY
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 1:1919 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-5601
Mailing Address - Country:US
Mailing Address - Phone:631-689-6560
Mailing Address - Fax:631-689-6560
Practice Address - Street 1:1919 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-5601
Practice Address - Country:US
Practice Address - Phone:631-689-6560
Practice Address - Fax:631-689-6560
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01371789Medicaid
NY01371789Medicaid
NYV3A921Medicare UPIN