Provider Demographics
NPI:1932982238
Name:HABERLAND, KEN (LADC)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:HABERLAND
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HALLS BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RUMNEY
Mailing Address - State:NH
Mailing Address - Zip Code:03266-4202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:446 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-4521
Practice Address - Country:US
Practice Address - Phone:603-536-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1265101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)