Healthcare Provider Details

I. General information

NPI: 1528111663
Provider Name (Legal Business Name): JEFFREY HABER ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S MADISON ST SUITE 332
DENVER CO
80209-3011
US

IV. Provider business mailing address

155 S MADISON ST SUITE 332
DENVER CO
80209-3011
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-2277
  • Fax:
Mailing address:
  • Phone: 303-321-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number470
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: