Provider Demographics
NPI:1356401475
Name:HAVEN, HOWARD JOEL (PHD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JOEL
Last Name:HAVEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12690 W NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-785-9188
Mailing Address - Fax:262-785-0644
Practice Address - Street 1:12690 W NORTH AVENUE
Practice Address - Street 2:ELMBROOK FAMILY COUNSELING CENTER
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-785-9188
Practice Address - Fax:262-785-0644
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical