Provider Demographics
NPI:1588200513
Name:HAVEN PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:HAVEN PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-357-2057
Mailing Address - Street 1:724 YORKLYN RD STE 315
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8733
Mailing Address - Country:US
Mailing Address - Phone:302-357-2057
Mailing Address - Fax:302-304-3985
Practice Address - Street 1:724 YORKLYN RD STE 315
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8733
Practice Address - Country:US
Practice Address - Phone:302-357-2057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty