Provider Demographics
NPI:1982850848
Name:HAVERLY, COLLEEN (RN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:HAVERLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1037
Mailing Address - Country:US
Mailing Address - Phone:518-587-8800
Mailing Address - Fax:518-583-3311
Practice Address - Street 1:254 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1037
Practice Address - Country:US
Practice Address - Phone:518-587-8800
Practice Address - Fax:518-583-3311
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424968-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)