Provider Demographics
NPI:1255862082
Name:HAVERMANN, ROBIN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:HAVERMANN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 GANDER COVE LN
Mailing Address - Street 2:14
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8331
Mailing Address - Country:US
Mailing Address - Phone:314-610-2810
Mailing Address - Fax:
Practice Address - Street 1:6220 THERMAL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5630
Practice Address - Country:US
Practice Address - Phone:704-227-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist