Provider Demographics
NPI:1730655440
Name:HABER, KALI NICOLE
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:NICOLE
Last Name:HABER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 N RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1635
Mailing Address - Country:US
Mailing Address - Phone:615-479-5336
Mailing Address - Fax:520-413-2119
Practice Address - Street 1:2818 N RALPH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1635
Practice Address - Country:US
Practice Address - Phone:615-479-5336
Practice Address - Fax:520-413-2119
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician