| Doctor Name: | DR. RAYMOND J HAVLICEK |
| NPI Number: | 1215152095 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 004718 |
| Business Practice Address: | 30 Cayuga Way Lake Placid, NY - 129463915 |
| Business Phone Number: | 5184419426 |
| Business Fax Number: | 5167769275 |
| Mailing Address: | 30 Cayuga Way, LAKE PLACID |
| State: | NY |
| Postal Code: | 129463915 |
| Phone Number: | 5184419426 |
| Fax Number: | 5167769275 |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 04/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0200X |
| License Number: | 004718 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Forensic |
| Taxonomy Definition: | |