MEDICARE: DR. SEAN BARRY HAGGERTY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	011380	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720075526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN BARRY HAGGERTY PH.D.

Provider Business Mailing Address
First Line	:	1919 MIDDLE COUNTRY RD
Second Line	:	SUITE 201
City	:	CENTEREACH
State	:	NY
Zip	:	11720-5601
Country	:	US
Telephone Number	:	631-689-6560
Fax Number	:	631-689-6560

Provider Business Practice Location Address
First Line	:	1919 MIDDLE COUNTRY RD
Second Line	:	SUITE 201
City	:	CENTEREACH
State	:	NY
Zip	:	11720-5601
Country	:	US
Telephone Number	:	631-689-6560
Fax Number	:	631-689-6560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	10/08/2011

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