Healthcare Provider Details

I. General information

NPI: 1316635592
Provider Name (Legal Business Name): MR. HAVEN JAMES WINTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HAVEN JAMES CARTE

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 VALLEY CREEK DR STE I
ELGIN IL
60123-2694
US

IV. Provider business mailing address

4829 N KIMBALL AVE APT 1
CHICAGO IL
60625-5181
US

V. Phone/Fax

Practice location:
  • Phone: 630-566-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: