Provider Demographics
NPI:1316480221
Name:HAAS, JEANIE
Entity type:Individual
Prefix:MS
First Name:JEANIE
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 GOODROW CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6572
Mailing Address - Country:US
Mailing Address - Phone:609-647-6376
Mailing Address - Fax:
Practice Address - Street 1:14101 GOODROW CT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6572
Practice Address - Country:US
Practice Address - Phone:609-647-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04330200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health