Healthcare Provider Details

I. General information

NPI: 1447316450
Provider Name (Legal Business Name): ROBERT J HAAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 N 12TH ST BLDG 29M
QUINCY IL
62301-1397
US

IV. Provider business mailing address

1707 N 12TH ST BLDG 29M
QUINCY IL
62301-1397
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-8641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: