Provider Demographics
NPI:1376711986
Name:HABER, PHYLLIS
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:HABER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 79TH ST
Mailing Address - Street 2:#35
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0150
Mailing Address - Country:US
Mailing Address - Phone:212-879-5855
Mailing Address - Fax:212-879-0148
Practice Address - Street 1:16 E 79TH ST
Practice Address - Street 2:#35
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0150
Practice Address - Country:US
Practice Address - Phone:212-879-5855
Practice Address - Fax:212-879-0148
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036710R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN95351Medicare PIN