Provider Demographics
NPI:1932428505
Name:HAATVEDT, LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:HAATVEDT
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 1:2400 15TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3394
Mailing Address - Country:US
Mailing Address - Phone:772-532-8310
Mailing Address - Fax:
Practice Address - Street 1:2400 15TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3394
Practice Address - Country:US
Practice Address - Phone:772-532-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health