Healthcare Provider Details

I. General information

NPI: 1740515667
Provider Name (Legal Business Name): RICARDO E HABER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 37TH AVE SUITE 408
JACKSON HEIGHTS NY
11372-6300
US

IV. Provider business mailing address

7409 37TH AVE SUITE 408
JACKSON HEIGHTS NY
11372-6300
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-2263
  • Fax: 718-779-2225
Mailing address:
  • Phone: 718-779-2263
  • Fax: 718-779-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP71746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: