Provider Demographics
NPI:1811428725
Name:HABIB, ADRIENNE DANIELLE (PSYD)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:DANIELLE
Last Name:HABIB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5244
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92165-5244
Mailing Address - Country:US
Mailing Address - Phone:760-635-3310
Mailing Address - Fax:
Practice Address - Street 1:355 SANTA FE DR STE 200
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5153
Practice Address - Country:US
Practice Address - Phone:760-635-3310
Practice Address - Fax:760-230-9291
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY33054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program