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NPI Code Detail

MEDICARE: ILLYSE S. HABBE PSY.D.

MEDICARE: ILLYSE S. HABBE PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TH0100XHealth Service Psychologist6697MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1014854OTHERMAHARVARD PILGRIM/PACIFICAR
2486857OTHERMATUFTS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386731743
Entity Type Code : Individual
Provider Name (Legal Business Name) : ILLYSE S. HABBE PSY.D.
Provider Business Mailing Address
First Line : 18 TOLMAN ST
Second Line :
City : SHARON
State : MA
Zip : 02067-2129
Country : US
Telephone Number : 781-784-2431
Fax Number : 781-784-2431
Provider Business Practice Location Address
First Line : 15 COTTAGE ST
Second Line : SUITE 3
City : NORWOOD
State : MA
Zip : 02062-2153
Country : US
Telephone Number : 781-784-2431
Fax Number : 781-784-2431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 07/08/2007

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