Provider Demographics
NPI:1275107658
Name:HAASE, HEATHER (LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HAASE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HAASE BERNATCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1223
Mailing Address - Country:US
Mailing Address - Phone:203-290-2651
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1223
Practice Address - Country:US
Practice Address - Phone:203-290-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist