Healthcare Provider Details

I. General information

NPI: 1770393407
Provider Name (Legal Business Name): LAUREN MARIE HAAS-SULZER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARIE HAAS

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 DANBY RD STE 202F
ITHACA NY
14850-5714
US

IV. Provider business mailing address

950 DANBY RD STE 202F
ITHACA NY
14850-5714
US

V. Phone/Fax

Practice location:
  • Phone: 607-260-3100
  • Fax:
Mailing address:
  • Phone: 607-260-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: