Healthcare Provider Details

I. General information

NPI: 1316928245
Provider Name (Legal Business Name): TEDD R. HABBERFIELD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 S CAYUGA RD
WILLIAMSVILLE NY
14221-6705
US

IV. Provider business mailing address

37 S CAYUGA RD
WILLIAMSVILLE NY
14221-6705
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-7492
  • Fax: 716-626-4496
Mailing address:
  • Phone: 716-626-7492
  • Fax: 716-626-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number011033
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number011033
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011033
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number011033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: