Provider Demographics
NPI:1659423945
Name:HAVEN, TERRI (MSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:HAVEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2104
Mailing Address - Country:US
Mailing Address - Phone:413-221-0546
Mailing Address - Fax:
Practice Address - Street 1:41 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2104
Practice Address - Country:US
Practice Address - Phone:413-221-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10298461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07445OtherBCBS PROVIDER NUMBER
MA1857266Medicaid
MAP20872Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER