MEDICARE: DR. THOMAS A HABIB PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0700X	Adult Development & Aging Psychologist	PSY9509	CA
2	103TC0700X	Clinical Psychologist	PSY9509	CA
3	103TC2200X	Clinical Child & Adolescent Psychologist	PSY9509	CA
4	103TF0000X	Family Psychologist	PSY9509	CA
5	103TH0100X	Health Service Psychologist	PSY9509	CA
6	103T00000X	Psychologist	PSY9509	CA
7	103TP2701X	Group Psychotherapy Psychologist	PSY9509	CA

General Provider Information

NPI Number	:	1316001514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A HABIB PH.D.

Provider Business Mailing Address
First Line	:	31897 DEL OBISPO ST STE 250
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3243
Country	:	US
Telephone Number	:	949-248-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	31897 DEL OBISPO ST STE 250
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3243
Country	:	US
Telephone Number	:	949-248-7411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	10/31/2012

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