Provider Demographics
NPI:1831234657
Name:HAVENS, PAMELA F (PHD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:HAVENS
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 1:4330 E CORRAL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5577
Mailing Address - Country:US
Mailing Address - Phone:623-691-4918
Mailing Address - Fax:623-691-4920
Practice Address - Street 1:6308 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-2731
Practice Address - Country:US
Practice Address - Phone:623-691-4918
Practice Address - Fax:623-691-4920
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool