MEDICARE: JUDY P HAVNER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LSW643	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730187915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY P HAVNER LCSW

Provider Business Mailing Address
First Line	:	1231 SNOWDON DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-2953
Country	:	US
Telephone Number	:	865-687-7090
Fax Number	:

Provider Business Practice Location Address
First Line	:	5112 SCHUBERT RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-3832
Country	:	US
Telephone Number	:	865-687-7090
Fax Number	:	865-688-3767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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