Provider Demographics
NPI:1396772216
Name:HAVERLICK, JOHN JOSEPH (LCSWR)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:HAVERLICK
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BEEDE LN
Mailing Address - Street 2:
Mailing Address - City:KEENE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12943-2004
Mailing Address - Country:US
Mailing Address - Phone:518-963-4067
Mailing Address - Fax:
Practice Address - Street 1:10897 NYS ROUTE 9N,
Practice Address - Street 2:SUITE4
Practice Address - City:KEENE
Practice Address - State:NY
Practice Address - Zip Code:12942-9998
Practice Address - Country:US
Practice Address - Phone:518-576-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR009313-1101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist