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General NPI Number Information
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NPI Number | 1205939493
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Entity Type | Individual
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Provider Name | KENDRA LAUREN HAVEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 7 ROUTE 25A
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City | SMITHTOWN
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State | NY
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Zip | 11787-1626
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Country | US
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Telephone | 631-724-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 65 CHESTNUT HILL RD
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City | STONE RIDGE
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State | NY
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Zip | 12484-5562
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Country | US
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Telephone | 845-687-7067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 008198
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 008198
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License Number State | NY
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