Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 35SI00533500 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00533500 | NJ |
Y | 103TR0400X | Rehabilitation Psychologist | 35SI00533500 | NJ |
NPI | 1225437197 |
---|---|
Provider Name | Dr. Kyle Haggerty |
First Address | Cherry Hill, NJ 08034-3220 |
Second Address | Cherry Hill, NJ 08034-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2014 |
Last Update Date | 01/09/2015 |