Provider Demographics
NPI:1528377728
Name:HAVENS, SABRINA (LAC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:HAVENS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 166TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2275
Mailing Address - Country:US
Mailing Address - Phone:917-576-7863
Mailing Address - Fax:
Practice Address - Street 1:425 NORTHERN BLVD STE 21
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4803
Practice Address - Country:US
Practice Address - Phone:917-576-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024322225700000X
NY00456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist