Provider Demographics
NPI:1386510980
Name:HABIBI, TAQWA
Entity type:Individual
Prefix:
First Name:TAQWA
Middle Name:
Last Name:HABIBI
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 1:26540 DEAL ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-2430
Mailing Address - Country:US
Mailing Address - Phone:775-846-2500
Mailing Address - Fax:
Practice Address - Street 1:1147 S SALISBURY BLVD
Practice Address - Street 2:8-143
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-6865
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician