Provider Demographics
NPI:1366544439
Name:HAFKEN, LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:HAFKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 SHERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-5655
Mailing Address - Country:US
Mailing Address - Phone:561-445-9361
Mailing Address - Fax:561-499-4275
Practice Address - Street 1:16158 S MILITARY TRL
Practice Address - Street 2:SOUTH COUNTY MENTAL HEALTH CENTER
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6502
Practice Address - Country:US
Practice Address - Phone:561-495-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD047822084P0800X
MA521612084P0800X
FLME770432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057829Medicaid
RI295422OtherBLUE CROSS BLUE SHIELD
RI1528859OtherUNITED BEHAVIORAL HEALTH
RI003054OtherBLUE CHIP
RI295422OtherBLUE CROSS BLUE SHIELD
RI007057829Medicare ID - Type Unspecified