Healthcare Provider Details

I. General information

NPI: 1790596872
Provider Name (Legal Business Name): HAVEN PSYCHOTHERAPY LICENSED CLINICAL SOCIAL WORKER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 QUAIL ST STE 220
NEWPORT BEACH CA
92660-2767
US

IV. Provider business mailing address

1000 QUAIL ST STE 220
NEWPORT BEACH CA
92660-2767
US

V. Phone/Fax

Practice location:
  • Phone: 949-484-8124
  • Fax:
Mailing address:
  • Phone: 949-484-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA OWEN
Title or Position: CEO AND FOUNDER
Credential: MSW, M.ED., LCSW
Phone: 949-484-8124