Provider Demographics
NPI:1376063008
Name:JABATEH, HUMPHREY (MHS)
Entity Type:Individual
Prefix:
First Name:HUMPHREY
Middle Name:
Last Name:JABATEH
Suffix:
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1417
Mailing Address - Country:US
Mailing Address - Phone:215-532-4206
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST STE 1350
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4019
Practice Address - Country:US
Practice Address - Phone:215-664-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health