Provider Demographics
NPI:1194452466
Name:HAAS, EDWARD GERARD (LCADC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:GERARD
Last Name:HAAS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 ANDERSON AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1888
Mailing Address - Country:US
Mailing Address - Phone:201-654-4086
Mailing Address - Fax:201-942-2320
Practice Address - Street 1:596 ANDERSON AVE STE 305
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1888
Practice Address - Country:US
Practice Address - Phone:201-654-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00302700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)