Provider Demographics
NPI:1568452423
Name:HABREL, ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:HABREL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 N 124TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4622
Mailing Address - Country:US
Mailing Address - Phone:262-641-4347
Mailing Address - Fax:262-641-4350
Practice Address - Street 1:2511 N 124TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4622
Practice Address - Country:US
Practice Address - Phone:262-641-4347
Practice Address - Fax:262-641-4350
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1316-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39200400Medicaid
WI000584075Medicare PIN
WI39200400Medicaid