Provider Demographics
NPI:1730386269
Name:HAVEY, JOHN THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:HAVEY
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 1:4935 61ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5703
Mailing Address - Country:US
Mailing Address - Phone:808-284-7770
Mailing Address - Fax:888-371-4292
Practice Address - Street 1:9093 ELK GROVE BLVD # 206
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2047
Practice Address - Country:US
Practice Address - Phone:808-284-7770
Practice Address - Fax:888-371-4292
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21388103T00000X
HI1124103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1124OtherPSYCHOLOGIST LICENSE
CA21388OtherPSYCHOLOGIST LICENSE