Provider Demographics
NPI:1396334645
Name:HAVLICK, JOSEPH TILTON (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TILTON
Last Name:HAVLICK
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:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-0671
Mailing Address - Country:US
Mailing Address - Phone:610-955-9165
Mailing Address - Fax:
Practice Address - Street 1:146 MERION AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2415
Practice Address - Country:US
Practice Address - Phone:610-955-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor