Provider Demographics
NPI:1053551713
Name:HAVEN, ERIN LAURA (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LAURA
Last Name:HAVEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LAURA
Other - Last Name:RISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1001 PARTRIDGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-0714
Mailing Address - Country:US
Mailing Address - Phone:424-284-2440
Mailing Address - Fax:
Practice Address - Street 1:1001 PARTRIDGE DR STE 110
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-0714
Practice Address - Country:US
Practice Address - Phone:424-284-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KS2483103TB0200X
CAPSY28043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760692750OtherTELECARE CORPORATION