Provider Demographics
NPI:1689795015
Name:HABER, PHILLIP B (MS, PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:B
Last Name:HABER
Suffix:
Gender:M
Credentials:MS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 5TH AVE S
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2540
Mailing Address - Country:US
Mailing Address - Phone:612-333-2155
Mailing Address - Fax:612-333-5517
Practice Address - Street 1:155 5TH AVE S
Practice Address - Street 2:SUITE 450
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2540
Practice Address - Country:US
Practice Address - Phone:612-333-2155
Practice Address - Fax:612-333-5517
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1655103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation