Provider Demographics
NPI:1083751770
Name:PHILIP I. HABER, LTD.
Entity Type:Organization
Organization Name:PHILIP I. HABER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:I
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-476-2348
Mailing Address - Street 1:11123 TIMBERHEAD CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4700
Mailing Address - Country:US
Mailing Address - Phone:703-476-2348
Mailing Address - Fax:703-476-6013
Practice Address - Street 1:12050 S LAKES DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1220
Practice Address - Country:US
Practice Address - Phone:703-476-2348
Practice Address - Fax:703-476-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000976101YP2500X
VA09040008821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
158333OtherVALUE OPTIONS
7233-0001OtherCARE FIRST
30679OtherCIGNA
7751097OtherAETNA
1036558OtherCIGNA
126400OtherVALUE OPTIONS
223114OtherANTHEM
7650215OtherAETNA
7233-0004OtherCARE FIRST
063138OtherANTHEM