Healthcare Provider Details

I. General information

NPI: 1366539280
Provider Name (Legal Business Name): ROBERT HAVEL PSY.D.,L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLEARY LN
EAGAN MN
55123-2340
US

IV. Provider business mailing address

11613 KENNELLY CIR
BURNSVILLE MN
55337-3275
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-0114
  • Fax: 651-454-3492
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1061
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: