Provider Demographics
NPI:1750994794
Name:WILLIAMS HAVERTY, TONI
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:WILLIAMS HAVERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2707
Mailing Address - Country:US
Mailing Address - Phone:201-820-2532
Mailing Address - Fax:
Practice Address - Street 1:283 BERRY ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2707
Practice Address - Country:US
Practice Address - Phone:201-820-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06268300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health