Provider Demographics
NPI:1508757766
Name:HAVRILLA, EMMA GRACE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:GRACE
Last Name:HAVRILLA
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 1:12 HILLSIDE PL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1911
Mailing Address - Country:US
Mailing Address - Phone:631-807-1352
Mailing Address - Fax:
Practice Address - Street 1:12 HILLSIDE PL
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1911
Practice Address - Country:US
Practice Address - Phone:631-807-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health