Provider Demographics
NPI:1194133447
Name:HARVEY, JUSTYN
Entity type:Individual
Prefix:
First Name:JUSTYN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1549
Mailing Address - Country:US
Mailing Address - Phone:561-279-3852
Mailing Address - Fax:561-437-8116
Practice Address - Street 1:66 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-1549
Practice Address - Country:US
Practice Address - Phone:561-279-3852
Practice Address - Fax:561-437-8116
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-24300103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst