Provider Demographics
NPI:1629686274
Name:SAFE HAVEN THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:SAFE HAVEN THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOT SALAU
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW-C
Authorized Official - Phone:301-437-0485
Mailing Address - Street 1:6572 ELDERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6485
Mailing Address - Country:US
Mailing Address - Phone:301-437-0485
Mailing Address - Fax:
Practice Address - Street 1:6572 ELDERBERRY CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6485
Practice Address - Country:US
Practice Address - Phone:301-437-0485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty