Provider Demographics
NPI:1053061796
Name:HOPE HAVEN THERAPY PLLC
Entity Type:Organization
Organization Name:HOPE HAVEN THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:888-948-6789
Mailing Address - Street 1:1 KALISA WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3508
Mailing Address - Country:US
Mailing Address - Phone:888-948-6789
Mailing Address - Fax:877-345-3501
Practice Address - Street 1:1610 SCRANTON AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2676
Practice Address - Country:US
Practice Address - Phone:888-948-6789
Practice Address - Fax:877-345-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty