Provider Demographics
NPI:1427383223
Name:HAVEL, THERESA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:HAVEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:KOVACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 MONTAGE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1782
Mailing Address - Country:US
Mailing Address - Phone:570-346-3686
Mailing Address - Fax:570-558-6838
Practice Address - Street 1:340 MONTAGE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1782
Practice Address - Country:US
Practice Address - Phone:570-346-3686
Practice Address - Fax:570-558-6838
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016798103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026969730001Medicaid