Provider Demographics
NPI:1386731743
Name:HABBE, ILLYSE S (PSYD)
Entity type:Individual
Prefix:
First Name:ILLYSE
Middle Name:S
Last Name:HABBE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ILLYSE
Other - Middle Name:
Other - Last Name:SHINDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 TOLMAN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2129
Mailing Address - Country:US
Mailing Address - Phone:781-784-2431
Mailing Address - Fax:781-784-2431
Practice Address - Street 1:15 COTTAGE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2153
Practice Address - Country:US
Practice Address - Phone:781-784-2431
Practice Address - Fax:781-784-2431
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6697103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA014854OtherHARVARD PILGRIM/PACIFICAR
MA486857OtherTUFTS
MA0596485Medicaid
MAW05401Medicare ID - Type Unspecified