Provider Demographics
NPI:1497892269
Name:HABER, PHILIP I (MS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:I
Last Name:HABER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 S LAKES DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1220
Mailing Address - Country:US
Mailing Address - Phone:703-476-2348
Mailing Address - Fax:703-476-6013
Practice Address - Street 1:12050 S LAKES DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1220
Practice Address - Country:US
Practice Address - Phone:703-476-2348
Practice Address - Fax:703-476-6013
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
30679OtherCIGNA
7650215OtherAETNA
VA063138OtherANTHEM
126400OtherVALUE OPTIONS
7233-0001OtherCARE FIRST