Provider Demographics
NPI:1962559880
Name:HAEBERLE, KAREN CONSTANCE (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:CONSTANCE
Last Name:HAEBERLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:115 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3182
Mailing Address - Country:US
Mailing Address - Phone:413-525-2166
Mailing Address - Fax:413-525-8604
Practice Address - Street 1:167 DWIGHT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1752
Practice Address - Country:US
Practice Address - Phone:413-525-2166
Practice Address - Fax:412-525-8604
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05236Medicare ID - Type Unspecified