Healthcare Provider Details

I. General information

NPI: 1700169950
Provider Name (Legal Business Name): KATE HAFFNER LCMT, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 RESERVOIR AVE SUITE 210
CRANSTON RI
02920-6055
US

IV. Provider business mailing address

6 CHURCH ST
WARREN RI
02885-3123
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-3151
  • Fax:
Mailing address:
  • Phone: 203-815-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT01359
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: