Provider Demographics
NPI:1922398460
Name:HAVERTY, CAPRICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAPRICE
Middle Name:
Last Name:HAVERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2608
Mailing Address - Country:US
Mailing Address - Phone:925-685-9670
Mailing Address - Fax:925-685-1528
Practice Address - Street 1:2827 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2608
Practice Address - Country:US
Practice Address - Phone:925-685-9670
Practice Address - Fax:925-685-1528
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13202103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic