Provider Demographics
NPI:1003259094
Name:HAVENS, MICHELE CAROL (MICHELE HAVENS, EDD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:CAROL
Last Name:HAVENS
Suffix:
Gender:F
Credentials:MICHELE HAVENS, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MANKER DR
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2309
Mailing Address - Country:US
Mailing Address - Phone:201-486-5607
Mailing Address - Fax:973-377-6769
Practice Address - Street 1:5 MANKER DR
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2309
Practice Address - Country:US
Practice Address - Phone:201-486-5607
Practice Address - Fax:973-377-6769
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2196985174400000X
NJ1-21-55564103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist