Provider Demographics
NPI:1609978568
Name:HAASE-SMITH, JULIE ANN (LCSW-R)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HAASE-SMITH
Suffix:
Gender:
Credentials:LCSW-R
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HAASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4476 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4463
Mailing Address - Country:US
Mailing Address - Phone:716-512-5279
Mailing Address - Fax:
Practice Address - Street 1:4476 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4463
Practice Address - Country:US
Practice Address - Phone:716-512-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063934-1104100000X
NY0808001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04355226Medicaid
NY01465154Medicaid