Provider Demographics
NPI:1780219824
Name:HABER, STEPHANIE (RD LDN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HABER
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COLBORNE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4842
Mailing Address - Country:US
Mailing Address - Phone:949-300-7187
Mailing Address - Fax:
Practice Address - Street 1:50 CONGRESS ST STE 205
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4054
Practice Address - Country:US
Practice Address - Phone:949-300-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered