Provider Demographics
NPI:1710130307
Name:MCNEIL-HABER, FAWN MEGAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FAWN
Middle Name:MEGAN
Last Name:MCNEIL-HABER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 PARK AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1754
Mailing Address - Country:US
Mailing Address - Phone:908-242-3634
Mailing Address - Fax:
Practice Address - Street 1:567 PARK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1754
Practice Address - Country:US
Practice Address - Phone:908-242-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017169103TC0700X
NJ35SI00456800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical