Healthcare Provider Details

I. General information

NPI: 1215622410
Provider Name (Legal Business Name): JESSICA HABASHY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 W SANTA CLARA ST STE 700
SAN JOSE CA
95113-1809
US

IV. Provider business mailing address

10001 FOX SPRINGS DR
LAS VEGAS NV
89117-0944
US

V. Phone/Fax

Practice location:
  • Phone: 858-208-0380
  • Fax:
Mailing address:
  • Phone: 702-343-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: