Healthcare Provider Details

I. General information

NPI: 1215090568
Provider Name (Legal Business Name): PATRICIA ANN HAAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 BROADWAY SUITE 100 KAISER PERMANENTE VALLEJO MEDICAL CENTER DEPT OF PSYCIA
VALLEJO CA
94589-2485
US

IV. Provider business mailing address

564 WILLOW COURT
BENICIA CA
94510-1447
US

V. Phone/Fax

Practice location:
  • Phone: 707-645-2700
  • Fax: 707-645-2181
Mailing address:
  • Phone: 707-746-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLIC6071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: