1225100886 NPI number — MS. MARTHA JANET HABERT LCSW

Table of content: MS. MARTHA JANET HABERT LCSW (NPI 1225100886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225100886 NPI number — MS. MARTHA JANET HABERT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABERT
Provider First Name:
MARTHA
Provider Middle Name:
JANET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1225100886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24920 ELKMONT AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEROSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11426-2631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-343-4468
Provider Business Mailing Address Fax Number:
718-343-4468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11050 71 ROAD
Provider Second Line Business Practice Location Address:
STE 1N
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-4972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-261-6247
Provider Business Practice Location Address Fax Number:
718-343-4468
Provider Enumeration Date:
11/15/2006

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: 1041C0700X , with the licence number:  R0245841 , 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)

  • Identifier: 01644802 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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