1538481403 NPI number — MIRTA I HABER LMSW

Table of content: MIRTA I HABER LMSW (NPI 1538481403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538481403 NPI number — MIRTA I HABER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABER
Provider First Name:
MIRTA
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538481403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4404 QUEENS BLVD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11104-2406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-706-1663
Provider Business Mailing Address Fax Number:
718-706-0635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4404 QUEENS BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11104-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-706-1663
Provider Business Practice Location Address Fax Number:
718-706-0635
Provider Enumeration Date:
02/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  080712 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)