Individual
KENDRA LAUREN HAVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
7 ROUTE 25A, SMITHTOWN, NY 11787-1626
(631) 724-2200
Mailing address
65 CHESTNUT HILL RD, STONE RIDGE, NY 12484-5562
(845) 687-7067
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
008198
NY
103TC0700X
Clinical Psychologist
Primary
008198
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00906487
—
NY
Enumeration date
09/06/2006
Last updated
06/02/2009
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