Provider Demographics
NPI:1477318426
Name:HAVENS, MARIAH (QMHS)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:HAVENS
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1262
Mailing Address - Country:US
Mailing Address - Phone:740-343-6135
Mailing Address - Fax:740-342-2914
Practice Address - Street 1:113 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1262
Practice Address - Country:US
Practice Address - Phone:740-343-6135
Practice Address - Fax:740-342-2914
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator