Provider Demographics
NPI:1609084672
Name:HAVENS, DOROTHY SR
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:HAVENS
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:748 S NEW ST
Practice Address - Street 2:SUITES C & D
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3573
Practice Address - Country:US
Practice Address - Phone:302-734-3227
Practice Address - Fax:302-374-0391
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN0000160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036065Medicaid
491147Medicare UPIN
DE1000036065Medicaid