Provider Demographics
NPI:1467692053
Name:HARVEL, WAYNE (ASW)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HARVEL
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500B JEFFERSON BLVD # 180
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2349
Mailing Address - Country:US
Mailing Address - Phone:916-403-2970
Mailing Address - Fax:916-403-2971
Practice Address - Street 1:500B JEFFERSON BLVD # 180
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2349
Practice Address - Country:US
Practice Address - Phone:916-403-2970
Practice Address - Fax:916-403-2971
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-H0611141540174400000X
CA32628104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist