Provider Demographics
NPI:1538481403
Name:HABER, MIRTA I (LMSW)
Entity Type:Individual
Prefix:
First Name:MIRTA
Middle Name:I
Last Name:HABER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 QUEENS BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2406
Mailing Address - Country:US
Mailing Address - Phone:718-706-1663
Mailing Address - Fax:718-706-0635
Practice Address - Street 1:4404 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2406
Practice Address - Country:US
Practice Address - Phone:718-706-1663
Practice Address - Fax:718-706-0635
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080712104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker