Provider Demographics
NPI:1780705293
Name:HAAS, SANDRA HELENE (LICSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:HELENE
Last Name:HAAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746088
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6088
Mailing Address - Country:US
Mailing Address - Phone:469-727-6675
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:650 BRANCH AVE STE 6
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1728
Practice Address - Country:US
Practice Address - Phone:401-233-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6226514OtherUNITED BEHAVIORAL HEALTH
RI410639OtherBLUE CHIP
RI25730-9OtherBLUE CROSS & BLUE SHIELD
RI1021900OtherBEACON HEALTH STRATEGIES