Provider Demographics
NPI:1790920924
Name:HABER, SHELLEY JOAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JOAN
Last Name:HABER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FALL LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2311
Mailing Address - Country:US
Mailing Address - Phone:516-822-3161
Mailing Address - Fax:516-827-1941
Practice Address - Street 1:23 FALL LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2311
Practice Address - Country:US
Practice Address - Phone:516-822-3161
Practice Address - Fax:516-827-1941
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050172-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical