Provider Demographics
NPI:1104070713
Name:HAUSMAN, AMY R (LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:HAUSMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CEDAR RD APT B2
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3423
Mailing Address - Country:US
Mailing Address - Phone:917-334-8907
Mailing Address - Fax:
Practice Address - Street 1:109 CEDAR RD APT B2
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-3423
Practice Address - Country:US
Practice Address - Phone:917-334-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003802171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist