Provider Demographics
NPI:1114702677
Name:HAVEN'S TAPESTRY HUMAN SUPPORT PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:HAVEN'S TAPESTRY HUMAN SUPPORT PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LEADER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:223-848-0111
Mailing Address - Street 1:249 TROY RD
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-9626
Mailing Address - Country:US
Mailing Address - Phone:717-309-1661
Mailing Address - Fax:
Practice Address - Street 1:249 TROY RD
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9626
Practice Address - Country:US
Practice Address - Phone:717-309-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty