Provider Demographics
NPI:1417367806
Name:HAEBERLE, AMBER RAE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:HAEBERLE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1537
Mailing Address - Country:US
Mailing Address - Phone:610-679-1840
Mailing Address - Fax:
Practice Address - Street 1:118 MORRIS RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1537
Practice Address - Country:US
Practice Address - Phone:610-679-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health