Healthcare Provider Details

I. General information

NPI: 1366073439
Provider Name (Legal Business Name): HAVEN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 EASTON AVE TOWER 3 SUITE 3
SOMERSET NJ
08873-1648
US

IV. Provider business mailing address

1075 EASTON AVE TOWER 3 SUITE 3
SOMERSET NJ
08873-1648
US

V. Phone/Fax

Practice location:
  • Phone: 908-227-8940
  • Fax:
Mailing address:
  • Phone: 908-227-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN T FINNERTY
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 908-227-8940