Provider Demographics
NPI:1407162118
Name:HABER, DIANE SUE (MA CCC/SLP PC)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:SUE
Last Name:HABER
Suffix:
Gender:F
Credentials:MA CCC/SLP PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62-54 97TH PLACE 9K
Mailing Address - Street 2:
Mailing Address - City:REGO PARK QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:646-400-3225
Mailing Address - Fax:
Practice Address - Street 1:62-54 97TH PLACE 9K
Practice Address - Street 2:
Practice Address - City:REGO PARK QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:646-400-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003000-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist