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NPI Code Detail

MEDICARE: DR. ROXANNE HAIT PSYD

MEDICARE: DR. ROXANNE HAIT PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist4457AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14457OTHERAZSTATE LICENSE

General Provider Information

NPI Number : 1497176150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROXANNE HAIT PSYD
Provider Business Mailing Address
First Line : PO BOX 41191
Second Line :
City : PHOENIX
State : AZ
Zip : 85080-1191
Country : US
Telephone Number : 602-633-5474
Fax Number : 602-733-6471
Provider Business Practice Location Address
First Line : 3420 E SHEA BLVD STE 188
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-3354
Country : US
Telephone Number : 602-633-5474
Fax Number : 602-733-6471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2013
Last Update Date : 05/09/2022

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