Provider Demographics
NPI:1588996763
Name:HAUG, DEBORAH (MASTERS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HAUG
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RICHMOND SQ STE 112C
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5155
Mailing Address - Country:US
Mailing Address - Phone:401-352-5754
Mailing Address - Fax:401-719-0652
Practice Address - Street 1:1 RICHMOND SQ STE 112C
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5155
Practice Address - Country:US
Practice Address - Phone:401-352-5754
Practice Address - Fax:401-719-0652
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
RIMHC00457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid