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General NPI Number Information
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NPI Number | 1669874384
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Entity Type | Individual
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Provider Name | JONATHAN HABER PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 245 CHESAPEAKE AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-6038
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Country | US
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Telephone | 757-534-9710
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Fax | 757-928-8337
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Provider Business Mailing Address
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Address Line | 856 J CLYDE MORRIS BLVD SUITE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1318
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Country | US
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Telephone | 757-594-4006
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Fax | 757-534-5190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005083
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License Number State | VA
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