Healthcare Provider Details

I. General information

NPI: 1437013513
Provider Name (Legal Business Name): ETHAN JAMES HAIGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7376 LAKE WORTH RD
GREENACRES FL
33467-2529
US

IV. Provider business mailing address

14863 CHATHAM COURT
WEST PALM BEACH FL
33415
US

V. Phone/Fax

Practice location:
  • Phone: 561-788-4086
  • Fax:
Mailing address:
  • Phone: 484-502-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-1377816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: