Provider Demographics
NPI:1225373129
Name:HABASH, CONSTANCE L (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:L
Last Name:HABASH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:L
Other - Last Name:HABASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94026-0121
Mailing Address - Country:US
Mailing Address - Phone:650-996-2649
Mailing Address - Fax:
Practice Address - Street 1:125 WILLOW RD STE 205
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2799
Practice Address - Country:US
Practice Address - Phone:650-996-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35178106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist