Provider Demographics
NPI:1699719120
Name:HANEY, JOHN FREDERICK BROWN (M)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK BROWN
Last Name:HANEY
Suffix:
Gender:M
Credentials:M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 WARRENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1130
Mailing Address - Country:US
Mailing Address - Phone:860-429-8400
Mailing Address - Fax:860-429-5994
Practice Address - Street 1:354 WARRENVILLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1130
Practice Address - Country:US
Practice Address - Phone:860-429-8400
Practice Address - Fax:860-429-5994
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0123172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF51689Medicare UPIN