=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336658608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAVEN EMPOWERMENT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 GRAMATAN AVE STE 311
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-663-7201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 GRAMATAN AVE STE 311
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-663-7201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RUTH WARWICK
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 914-663-7201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 037506
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------