Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY9509 | CA |
N | 103T00000X | Psychologist | PSY9509 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY9509 | CA |
Y | 103G00000X | Clinical Psychologist | PSY9509 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY9509 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY9509 | CA |
N | 103TF0000X | Family Psychologist | PSY9509 | CA |
N | 103TH0100X | Health Service | PSY9509 | CA |
N | 103TP2701X | Group Psychotherapist | PSY9509 | CA |
NPI | 1316001514 |
---|---|
Provider Name | Dr. Thomas A Habib |
First Address | San Juan Capistrano, CA 92675-3243 |
Second Address | San Juan Capistrano, CA 92675-3243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 31/10/2012 |