Provider Demographics
NPI:1306920160
Name:HAESSIG, BETH L (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:L
Last Name:HAESSIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 RAINBOW TRL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1726
Mailing Address - Country:US
Mailing Address - Phone:973-627-5810
Mailing Address - Fax:
Practice Address - Street 1:76 BROADWAY STE 200F
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2739
Practice Address - Country:US
Practice Address - Phone:973-627-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4152103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent