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General NPI Number Information
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NPI Number | 1821389628
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Entity Type | Individual
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Provider Name | MS. JACQUELINE MARIE HAAS
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Gender | Female
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 400 FORT HILL AVE
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1159
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Country | US
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Telephone | 585-393-7561
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Fax |
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Provider Business Mailing Address
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Address Line | 149 WISHING VIEW DR # 13-D
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City | WEBSTER
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State | NY
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Zip | 14580-3150
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Country | US
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Telephone | 585-545-1946
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 050244-1
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License Number State | NY
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