Provider Demographics
NPI:1265438568
Name:HAINES, CHRISTINE D (MA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:HAINES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:D
Other - Last Name:HARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 ALETHIA DR # U-1085
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-8082
Mailing Address - Country:US
Mailing Address - Phone:860-486-2629
Mailing Address - Fax:608-486-4948
Practice Address - Street 1:2 ALETHIA DR # U-1085
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-8082
Practice Address - Country:US
Practice Address - Phone:860-486-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000363231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4208684Medicaid
CT640000192Medicare PIN