Healthcare Provider Details

I. General information

NPI: 1821100462
Provider Name (Legal Business Name): TIMOTHY HABEGGER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WATERVILLE RD
AVON CT
06001-2097
US

IV. Provider business mailing address

96 PEPPERIDGE TREE RD
WATERTOWN CT
06795-1807
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-2691
  • Fax:
Mailing address:
  • Phone: 860-945-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number004045
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: