Provider Demographics
NPI:1255647582
Name:HABER, BRADLEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:HABER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N HIATUS RD STE 213
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5206
Mailing Address - Country:US
Mailing Address - Phone:954-431-0411
Mailing Address - Fax:954-431-0413
Practice Address - Street 1:700 N HIATUS RD STE 213
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-431-0411
Practice Address - Fax:954-431-0413
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW87431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical